New Zealand Certificate in Public Health and

Health Promotion level 5 Course

721.505
Health Promotion
Assignment 2
Student name: Alexander
Grashchuk
Student ID: 10336008
Health Promotion
Portfolio Task 2
 PROJECT DESCRIPTON

The health issue addressed is the high and rising rates of STI among MSM (men who have sex with men)
community. The term STI is used instead of STD to highlight that STI are often asymptomatic and can only be
detected through testing. For this project STIs do not include HIV/AIDS but the most common in New Zealand
STI, in particular chlamydia, gonorrhoea, and syphilis.
Community of interest: MSM – men who have sex with men, as well as transgender women. Term MSM is used
in health promotion to focus on sexual practices rather than sexual orientation as some MSM self-identify as
heterosexual rather than gay or bisexual.
Writing an article for Gayxepress magazine or BodyPositive / Burnett Foundation website featuring detailed
information about the scope of this health issue, analysis of its probable causes and possible new preventative
measures. The article can be accompanied by health promotion posters to illustrate the main findings and
health protection strategies. This should act as a health intervention to increase awareness of the issue and as
well as to offer specific health promoting behaviours. Additionally, effectiveness of the currently explored
strategies is to be explored and the new initiatives considered.
An article could reach out to the target audience with maximum possible exposure, initiate discussion and
follow ups. It would allow for a factual analysis and evidence-based research into the best working overseas and
local practices, provide some insights and possibly offer new approaches to the issue.
 SITUATIONAL ANALYSIS
While HIV prevention in Aotearoa has been a success story with some of the lowest transmission rates in the world, the have been a
documented increase in STI cases, particularly syphilis and gonorrhoea, that are disproportionally affecting MSM population. MSM population not
only accounts for most cases of syphilis and gonorrhea, but it also has the highest rates of STI prevalence in population. In 2021, rates of
gonorrhoea among MSM were 5,322 per 100,000 people compared to 97 per 100,000 for men who have sex with women and 108 per 100,000 for
women who have sex with men. According to the Ministry of Health (2023), rates of syphilis per 100,000 people among MSM in 2021 were 458 per
100,000, compared with 5 per 100,000 in men who have sex with women, and in women. Moreover, STI cases are now on the rise, and the main
increase is in MSM, for example there was an 81 percent increase in syphilis cases in the second half of last year (ESR, 2023).

There is a range of determinants of health in relation to this issue. MSM sex is more prone to transmission of STD, MSM have usually
more sexual partners, more casual sexual partners, engage in more dangerous sexual practices in settings that can compromise safe sex (chemsex).
The underlying reasons behind some of the behaviours could be the social stigma and internalised homophobia, peer pressure, intergenerational
trauma. This could lead to unsafe sex practices while the social stigma can compromise medical disclosure, access to treatment and regular testing.
There are additional challenges affecting bisexual men, men of colour and transwomen.
 SITUATIONAL ANALYSIS continued
A characteristic feature of STIs is that they are often asymptomatic. An infected person can then be unknowingly passing it on to
other people. Untreated STIs can lead to serious health complications including development of cancers. This makes regular screening for STIs
very important for all sexually active MSM. While for sexually active adults in general population an annual sexual health check is recommended,
MSM with a new or multiple sexual partners are recommended be screened for STIs every 3 months (ASHM, n.d.).

Nevertheless, according to the latest SPOTS (2023) survey of nearly 4,000 MSM in New Zealand, almost 40% of the participants did
not have their sexual health test in the last 12 month. Of those who did, 27% had an STI detected. A quarter of people in the survey were taking
PrEP and therefore had to be tested for STIs every 3 months. The data from Burnett Foundation (2022) shows overall decline in numbers of both
HIV and STI tests administered in the last two years. This could be indicative of changing attitudes, with over 80 per cent of surveyed MSM
agreeing that HIV and AIDS are a less serious threat now than before (SPOTS, 2023). There likely to be even lesser awareness/concern about the
STIs. While both HIV and STI tests were in decline in recent years, according to the data from Burnett Centre, there were 2 times less STI tests
administered last year than HIV tests. While the number of in-person HIV and STI tests was nearly the same, majority of tests were home tests
and there were 3 times less STI home tests ordered than HIV home tests (Burnett Foundation, 2022).

Most STIs in New Zealand are diagnosed by primary

care practitioners (Ministry of Health, 2023) and elevated STI testing
was linked to GP’s awareness of their patient’s sexuality.
Nevertheless, 50% of the surveyed MSM did not disclose their
sexual practices to their GP, disclosure was particularly low among
bisexual and Asian men, who were also reporting lower STI check-
up rates (Ludlam et al., 2015). This highlights that “stigma and
discrimination prevent or delay people from accessing and
engaging with prevention and health services” (Ministry of Health,
2023).
 SITUATIONAL ANALYSIS continued
Another challenge is a continuous reduction in condom use in MSM that was further escalated with introduction of PrEP.
According to data from Burnett Foundation (2022), just in 4 years since 2016 number of MSM always using condoms during sex reduced
almost 2 times so that by 2020 just over 20 per cent of MSM were reporting consistent use of condoms. While condoms remain the most
universal tool in preventing most STIs, there is an increasing peer pressure in the community to have condomless sex. With growing
proportion of MSM switching from condoms to PrEP to protect themselves from HIV, they are becoming vulnerable to getting other STIs. A
New Zealand study (Saxton et al., 2022) recorded a high incidence of STIs in the first year of taking PrEP, as 2/3 of the participants were
diagnosed with an STI, some had several concurrent STIs while others got re-infected several times. Increase in STIs could also be explained
with increase in a number of partners usually associated with people switching to PrEP. According to a longitudinal study in Netherlands
(Coyer et al, 2022), participants from PrEP cohort were also more acceptive to have unprotected sex with HIV positive people, the group with
highest STI rates and STI complications. Nevertheless, the overall rate of STI occurrence in the group was in a slow but steady decline,
indicating a long-term benefit of the regular STI screening (Saxton et al., 2022) .
 SITUATIONAL ANALYSIS continued
Surveys in Australia and the UK indicate that around 10% of MSM taking PrEP to prevent HIV, are also taking antibiotics to prevent
STIs. The most common antibiotic is doxycycline. Reportedly it was used to prevent STI as early as in Vietnam war. In latest years, a range of studies
have been researching use of Doxy-PEP and Doxy-PrEP in various populations. Most studies concentrated on Doxy-PEP as it was considered more
effecint in preventing syphilis. Doxy-PEP was found to be effective for MSM and transgender women, but not for cis-women.

The latest controlled DoxyPEP study in the USA and Canada (The Ontario HIV Treatment Network, 2023) was conducted with people taking
HIV PrEP demonstrated nearly 70% overall efficiency of Doxy-PEP in preventing chlamydia, gonorrhoea, and syphilis. The study participants were taking
200mg (2 tablets) of doxycycline on a day they had condomless sext (no later than 72hrs after intercourse). Doxy-PEP was most effective in preventing
chlamydia (88%) and syphilis (87%), but least effective against gonorrhoea (55% risk reduction). An earlier study in Europe demonstrated no protecting
effect of Doxy-PEP against gonorrhoea but this could be explained by high (over 65% in the UK) prevalence there of a drug-resistant strain of
gonorrhoea that is cannot be treated by doxycycline. In DoxyPEP study in the US prevalence of drug-resistant gonorrhoea was 25% which is
comparable to New Zealand levels, therefore similar protective effect against gonorrhoea could be expected in Aotearoa.

Encouraged by the study results, the San Francisco Department of Public Health in 2022 began recommending Doxy-PEP for cisgender men
and trans women with a history of bacterial STis and condomless sex in December last year. San Francisco AIDS Foundation Clinic is now
recommending Doxy PEP to all MSM, trans women and trans men at risk for an STI. Nevertheless, New Zealand and Australian health authorities do
not yet endorse Doxy-PEP (Cornelisse et al., 2023). While acknowledging increasing evidence of its benefit they also express concerns about potential
harm, inviting balanced informative discussions between clinicians and patients who consider starting Doxy-PEP. The main concern is a possible
contribution of Doxy-PEP to growing drug resistance on an individual and population level. There are also concerns about possible long-term effects of
Doxy-PEP on individuals. However, doxycycline has been taken for malaria prophylactic for decades. As most other drugs, doxycycline has side-effects,
for example it is linked to increased sunlight sensitivity, and it can also affect digestion.

STD in MSM is a matter of interest from a range of organisations including the BodyPostitve, Burnett Foundation, sexual health clinics and
ESR
 CONSULTATION AND ENGAGEMENT

To design an effective program, it is important to involve people with a lived-in experience in MSM community to
understand the issue from inside as well as to learn the attitudes and trends in the community. It is also vital to consult with
the stakeholders from healthcare organisations to have a feedback of what can work and what is currently working and why. It
is also helpful to engage with people affected with STI to have their input. Fortunately, the author is an insider who is involved
in the community and volunteers for one of the main stakeholders (Burnett Foundation) so can informally discuss the project
in different settings and get a range of opinions from various people.
The goal of this consultations is to encourage meaningful collaboration of the stakeholders and community members
in the project to ensure the quality of the programme and its cohesiveness, promote inter-personal links within the
community and empower its even most disadvantaged members with the knowledge and health promotion skills.
Collaboration is the key and underlying message is that taking responsibility for the personal sexual health (protection and
increased testing) benefits the entire community. It therefore addresses underlying determinants of health including stigma
and internalized homophobia by promoting self-care, self-worth and self-respect, as well as belonging and engagement with
the community.
These processes are valuable to make the program viable for the community, identifying any gaps that need to be
addressed in current health promotion strategies as well as identifying any new opportunities. On-going consultations
encourage participation and uptake of the programme while a feedback from the community allows making any required
improvements. Built from the bottom-up project with an input of various stakeholders is more likely to be of a good quality
and have a good goof fit for the community needs and as such is more likely to be accepted in the community and endorsed by
its consulted members who could become its advocates.
 Long-term Goal and 3 SMART Objectives
GOAL: Decrease stigma and empower MSM to look after their sexual health

AIM: Address a recent increase in STI cases in MSM

OBJECTIVES:

1. Increase awareness of STI rates in MSM community

2. Promote existing methods of STI protection (condoms) and regular sex health check-ups.

3. Inform about a new prevention method (Doxycycline PEP) specifically for most at-risk group of MSM taking PrEP.

A trial intervention is proposed as a one-off event with a presentation of a brief informative article along with 3 posters promoting
use of condoms, regular STI check-ups and an emerging new STI prevention method of Doxy-PEP.

SPECIFIC – increase awareness, promote use

MEASURABLE – participants to be polled on-line after the event to measure any changes.

ACHIEAVABLE according to earlier surveys, MSM attitudes and awareness of STIs are changeable.

REALISTIC resources required for the intervention are available, the student is experienced in writing articles for gay publications
as well as in making health promotion posters. The student is a member of the two MSM social groups that can be used in the
intervention.

TIMEBOUND – an intervention to be delivered by mid- May 2023.

 Elements of Health Equity Assessment Tool
What are the inequalities?

Higher STI rates in MSM comparing to MSW and WSM: rates of gonorrhoea among MSM are 55 times higher, rates of syphilis are 91 times higher,
and rates of HIV are 348 times higher. (Ministry of Health, 2023). Apart from affecting physical health of MSM this also can contribute to their poorer
mental health, lower salaries (due to time off work) etc.

Who is most advantaged and how?

Heterosexual men and women, particularly of European origin, have lower incidents of STI comparing to MSM, and as a consequence, have better
health outcomes and quality of life.

How did the inequality occur and what maintains it?

Social stigma and internalised homophobia, peer pressure, intergenerational trauma result in inadequate testing rates, reduced condom use,
prominence of risky behaviors including multiple partners, casual sex, chemsex.

Where and how will you intervene?

Increase awareness of the issue by publishing and article accompanied by posters drawing attention to importance of testing and preventative
measures including possible use of Doxy-PEP. Interventions are to be targeted at MSM through their trusted channels and venues like Burnett
Foundation’s social group “Empower”, Express magazine.

How will your intervention improve Māori health outcomes and reduce inequalities for Māori?

Māori MSM have lower testing and condom use rates. Interventions aimed to promote regular STI testing and condom use shall be most beneficial
for them. It is vital to ensure that the project includes Māori MSM participants.
 Elements of Health Equity Assessment Tool continued
How could this intervention affect health inequalities?

This planned from within MSM community interventions are more likely to reach out the people who are most involved and connected in the community
whereas people on the fringe of the community like closeted people due to cultural and social stigma reasons, for example some Asian/Pacific people
and MSM who can self-identify as heterosexual can be less impacted. This could reduce efficiency of the program for this disadvantaged sub-groups of
MSM.

Who will benefit the most?

Knowledge about Doxy-PEP would be particularly beneficial for PreP users who are most vulnerable for STI with 60% annual STI prevalence in the group
it can help preventing individuals in this group from acquiring STIs.

What might the unintended consequences be?

There is a danger of internal and external stigmatisation of MSM due to release of the research data that can portrait MSM as preliminary carriers of STI,
slut-shame people on PreP reporting more sexual partners, blame MSM community for increase in drug-resistant STI as a possible consequence of
Doxy-PEP. On the other hand, promotion of Doxy-PEP can encourage reduction in the use of condoms, the most effective barrier to transmission of
most STIs. Another possible consequence is actually increase in detected STIs due to more active testing.

What will you do to make sure the intervention does reduce inequities?

It is important to ensure a sex-positive approach, that various sectors of the community can be targeted: people on PrEP made aware of Doxy-PEP and
people not taking PrEP reminded on the efficiency of condom use and regular check-up recommendations.

How will you know if inequalities have been reduced?

“Before” and “after” measures should be selected. Ideally, this should resultant in reduction of STI rates. However, this is a long-term goal that can not be
achieved immediately. The intervention can measure changes in awareness of the issue and intentions to make healthier choices.
 PROJECT OUTLINE
Preliminary research indicated 4 possible actions
1. Increasing awareness of the STIs: Article 3. Promoting regular STI testing: Poster
Suggested writing an article outlining high and rising Original idea was to promote regular STI testing by likening itto
rates of STIs in MSM, featuring analysis of its causes an annual/biannual WOF. After further research it was decided to
and offering a range pro-active measures. Illustrated feature testing along with a range of STI prevention tools
available including vaccination, PrEP, Condoms, Dental Dams,
with graphs for easier visualisation. See Appendix A. and Doxy-PEP. The poster was designed in a form of menu to
empower MSM by highlighting their personal choice in selecting
2. Promoting use of condoms: Poster the best protection strategy that better suits their own sexual
health needs.
Condoms remain the most universal prevention tools against
STIs yet their use in MSM has been in decline, particularly 4. Promoting Doxy-PEP: Poster
with availability of PrEP. Research shows that condoms are
perceived as a physical and psychological barrier to intimacy Originally proposed as a promotional poster about a new
and pleasure, a sign of oppression and a association with a evidence supported STI prevention method for the most
disease, they can cause discomfort and loss of erection. The vulnerable to STI group of MSM taking PrEP and engaging in
chosen playful message was to present condoms as a potential condomless sex. Due to the concerns about drug resistance and in
tool to enhance a sexual play, letting MSM have more fun. The view of no official endorsement of Doxy-PEP from the health
selected imagery (a pool ring with gay scenes) and language authorities as of April 2023, it was decided to present information
(“fun”, “safe” “play kit”) underlines sexiness, sensitivity, as a fact sheet instead presenting MSM with informative choice,
safety, and carefree joy. listing both pros and cons of Doxy-PEP. See Appendix B

Required Resources: Time, Labour, Information, PC, Printer, Materials

 HEALTH PROMOTION MODEL: TE PAE MAHUTONGA
Ngā Manukara or Leadership. Effective health promotion shall be a
Mauriora or Cultural Identity. For our project to be successful, it needs to be fitting collaborative effort between the different sectors of the community. This
well into queer culture. It should speak the same language so that the target community project was inspired by the meeting with Mark Fisher, executive director
can identify with it and support it. Strong cultural affiliation is empowering and of Body Positive, who advised about Doxy-PEP studies overseas. Sex-
supporting for mental strength. According to research, Involvement in the queer positive approach to STI prevention in MSM was highlighted in my
community was liked to informative awareness and acceptance of various health communications with Burnett Centre’s CEO Joe Rich. Personal
prevention programs like PrEP. Nevertheless, queer community is very diverse. communication involved correspondence with Public Health Physician at
Furthermore, some MSM do not identify with queer community at all. It is therefore ESR Julaa Scott, conversation with a pharmacist in Australia, health
important to consider nuanced promotion strategy for with different messages for promotion testers at Burnett Foundation, and interviews with several
different segments of the community, including MSM who identify as heterosexual. queer people.

Te Mana Whakahaere or Autonomy. This Health Promotion project

Waiora or Environment Protection. According to Durie (1999),
originated from within the community in consultation with the peers
Waiora is related to Mauriora but is extends into the external world
and addressing their unique circumstances and needs. The project
and has a spiritual element. By applying this principle to the health
promotion initiative, we are seeking a safe and healthy natural accentuates not only self-governance and autonomy of the community,
environment for MSM people to express their sexuality. An example of but also the autonomy and mana of individuals within the community.
healthy sex-positive environment could be free condom distribution Community members are empowered by their increased awareness of
and safe sex advertising in gay clubs and sex on the site venues. the issue and are encouraged to make their own choice between the
available health strategies that could be better addressing their lifestyle
and needs (condoms, Doxy-PEP or regular testing).
Te Oranga or Participation in Society. MSM represent a minor percent of the
population. Social isolation can have important health consequences. For Toiora or Healthy Lifestyles. This is the core of the
example, MSM who spend little time with their peers were more likely to agree current health promotion initiative with targeted
to unprotected sex. According to SPOTS (2022) survey, less than 60% of MSM interventions including promotion of condom use as an
are fully open about their sexual identity. Furthermore, less than 50% of MSM STI harm minimisation tool as well as risk management
believe that their GP is aware of their sexuality. Therefore, stigma can have direct for other at-risk groups by encouraging testing and
health implication on MSM, contributing to inadequate STI awareness and considering Doxy-PEeP as a potential STI prevention
testing. strategy.
 HEALTH PROMOTION COMPETENCIES

Aro matawai (Assess) Whatakina (Lead)

Aro matawai competency is demonstrated in Whatakina competency is demonstrated in

analysis of the determinants of health that are networking with stakeholders and wider
impacting health of MSM community and hinder community (Health Promotion Forum of New
equity (Health Promotion Forum of New Zealand, Zealand, 2012). Data was collected from ESR,
2012). A comprehensive review of the available Burnett Foundation and BodyPositive. Feedback
research data has been undertaken to analyse the was collected from MSM from different walks of
issue of raising STI rates in MSM community, find life. Empowering action was chosen for the
out its possible causes and evaluate possible actions. community, facilitating informative choice of the
The actions proposed based on existing assets of the community members to select the best strategy
prominent shareholders (Burnett Foundation, Body according to their individual health needs.
Positive) with the use of proven techniques (posters Emerging health challenges (drug resistance)
and on-line articles). have been considered.
 TIMELINE

• Literature Review, Consultations – April-May 2023

1

2
• Draft of the Article – Early April 2023

3
• Concepts of the Posters – Mid April 2023

4
• Feedback on Article and Posters – Late April 2023

5
• Intervention: Article and Posters – Early May 2023

6
• Evaluation of the Intervention – Mid May 2023
 EVALUATION
The purpose of evaluation was to deliver an intervention that is useful and actually works. Evaluation was conducted to ensure that the selected
strategies and processes bring expected results and also to compare efficiency of different strategies. Evaluation started from the beginning and was
continuously applied throughout the project to make ongoing adjustment as required using self-reflection and feedback from the stakeholders. For
example, changes to “More Fun With Condoms” poster included removal of reference to HIV to stay focused on other STIs that were at the core of the
project. On the other hand, information was added about ordering a free condom/lube kit by mail from Burnett Foundation as this call to action was
considered to making the poster more powerful in promoting the change.

Considering that the project was a pilot intervention, the evaluation was formative, to assess how appropriate and useful such intervention could
be in a wider community in real life. A combination of two evaluation methods was used: personal reflection using on-going analysis of the developing
concept ideas and comparing them with emerging new research, discussion with peers and brainstorming. The second method was documentation of
outcomes of the intervention through on-line survey of all participants (Appendix C) that provide both quantitative and qualitative data. This is covered
in the “results” section.

Evaluation through ongoing analysis of feedback from stakeholders and self-reflection provided additional insights, allowed for correction of the
article and inspired new approaches for possible future interventions as well. The poster to promote regular STI testing was re-conceptualised into a
poster highlighting a range of STI prevention methods available including vaccination and Doxy-PrEP/PEP along with using condoms and dental dams as
well as regular testing. That was considered more empowering by changing concept from authoritarian recommendation to informative choice. Originally
all different preventative options on the menu were in no particular order but after feedback from Burnett Centre’s manager they were sorted into three
distinct groups in relation to an intercourse as “starters”, “mains”, and “second courses”. Condoms were strategically placed in the centre highlighting
their crucial role in STI protection. Nevertheless, the concept shifted to giving the power to MSM in making their own choice of STI protection that better
suits their individual needs.

An exit on-line poll was selected to get quantifiable results showing effectiveness of the selected strategies and their comparative advantages.
Qualitative and quantitative data in combination reflection allowed to gain additional insights for future research and intervention’s design. For example,
inconsistencies between number of participants on PrEP and number of participants testing 4 times a year was identified failures in following guidelines
for PrEP prescriptions. Also, delivery of intervention by e-mail has been evaluated as inefficient. For most participants, the e-mail went into their spam
 RESULTS
According to the responses, the intervention was effective in raising the awareness of STIs in MSM, the
overage concern increased from 3.4 before the event to 4.1 after the event on the scale between 1 and 5. Most
participants also agreed that they learned something new about STI prevention. From the 4 strategies presented
the participants believed that the most efficient was a Doxy-PEP Factsheet Poster, followed by Protection
Menu Poster and Fun with Condoms posters. The Article was voted as least efficient. Nevertheless, majority of
participants (12 out of 17) still found the article efficient. Furthermore, only the article featured information about
the rising STI rates so increase in concern about STI prevention can be attributed to the article. Remarkably, in
optional comments the participants noted that "Information article is excellent but many won’t read it all". For a full
scale intervention other information channels can be considered to better engage with the audience like
Facebook/Instagram stories or TikTok/Youtube videos.

With regards to the possible change in attitudes and intention, nearly half of participated considered
better STI protection measures after the intervention. 8 participants will or might be testing for STIs regularly
with 8 participants already doing that. 8 participants were ready to consider using Doxy-PEP, but only 2 with
certainty while 8 people advised they will not. This could be explained with the lack of endorsement of Doxy-PEP in
Aotearoa and concerns about drug resistance. The 7 people would or might use condoms more often, but only
2 with certainty. Nevertheless, considering relatively low and decreasing use of condoms in MSM, this is a very
encouraging result as condoms remain the cheapest and most universal STI protection tool.

It was worrisome that nearly a quarter of the participants did not have an STI test within last year.
Furthermore, while there were 6 participants taking PrEP daily only 4 participants were testing every 3 months,
which is a requirement for PrEP prescription. During an informal discussion with participants of "Empower Yourself"
social group ran by Burnett Centre, it was found out that some GP are either ignorant or complacent and can renew
PrEP without STI testing done.

Overall, a trial intervention appeared to be successful. It appeared to increase awareness and concern
about STIs in MSM and most of the participants learned something new about STI prevention. It addressed the
inequity by pinpointing the scope of the issue, analysing the underlying reasons of it and promoting a change in
the community. It also increased community’s social capacity by providing the participants with an informative
choice of measures to addressing inequity, with nearly half of the participants now considering making a healthier
 References
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). (n.d.). Sexual Health Check. https://sti.guidelines.org.nz/sexual-health-check/

Burnett Foundation (2022). Impact Report 2022. https://www.burnettfoundation.org.nz/media/3792/audited-burnett-foundation-aotearoa-impact-report-30-june- 2022-for-issue.pdf

Coyer, L., Prins, M., Davidovich, U., Van Bilsen W,., Van Der Loeff, M., Hoomenborg, E., Matser, A., & Boyd, A. (2022). Trends in Sexual Behavior and Sexually Transmitted Infections After Initiating

Human Immunodeficiency Virus Pre-Exposure Prophylaxis in Men Who Have Sex with Men from Amsterdam, the Netherlands: A Longitudinal Exposure-Matched Study. AIDS Patient

Care STDS, 36(6), 208-218. https://doi.org/10.1089/apc.2021.0219

Cornelisse, V. J., Ong, J. J., Ryder, N., Ooi, C., Wong, A., Kenchington, P., ... & Medland, N. A. (2023). Interim position statement on doxycycline post-exposure prophylaxis (Doxy-PEP) for the

prevention of bacterial sexually transmissible infections in Australia and Aotearoa New Zealand – the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Sexual

Health, 20(2), 99-104. https://doi.org/10.1071/SH23011

Health Promotion Forum of New Zealand. (2012). Ngā Kaiakatanga Hauora mō Aotearoa: Health promotion competencies for Aotearoa-New Zealand.

https://canvas.manukau.ac.nz/courses/48321/discussion_topics/262756

Institute of Environmental Science and Research. (2023). Be Safe, Get Tested: Syphilis Increase Sparks Concern For Life-Threatening Impact On Unborn Babies. https://www.esr.cri.nz/home/about-

esr/media-releases/syphilis-increase-sparks-concern-2023.

Ludlam A.H., Saxton P.J., Dickson N.P., & Hughes A.J. (2015). General practitioner awareness of sexual orientation among a community and internet sample of gay and bisexual men in New

Zealand. Journal of primary health care, 7(3), 204-212. https://pubmed.ncbi.nlm.nih.gov/26437044/

 References

Ministry of Health. (2023). Aotearoa New Zealand Sexually Transmitted and Blood Borne Infection Strategy 2023-2030. Wellington: Ministry of Health.

https://www.health.govt.nz/system/files/documents/publications/stbbi_strategy_march_2023_final.docx

San Francisco AIDS Foundation. (2023). About Doxy PEP For Prevention of STIs. https://www.sfaf.org/collections/beta/about-doxy-pep-for-prevention-of-stis/

Saxton, P.J.W., Azariah, S., Cavadino, A. et al. (2022). Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months

Follow-up and Ethnic Disparities. AIDS Behaviour, 26, 2723–2737. https://doi.org/10.1007/s10461-022-03617-5

Signal, L., Martin, J., Cram, F. & Robson, B. (2008). The Health Equity Assessment Tool: A user guide. Ministry of Health.

https://www.health.govt.nz/system/files/documents/publications/health-equity-assessment-tool-guide.pdf

SPOTS., Sex And Prevention Of Transmission Study, (2023). Findings. https://www.spots.org.nz/findings

The Ontario HIV Treatment Network. (2023). Doxycycline prophylaxis for the prevention of bacterial sexually transmitted infections (STIs). https://www.ohtn.on.ca/rapid-response-

doxycycline-prophylaxis-for-the-prevention-of-bacterial-sexually-transmitted-infections/

Traeger MW, Guy R, Asselin J, et al. (2022). Real-world trends in incidence of bacterial sexually transmissible infections among gay and bisexual men using HIV pre-

exposure prophylaxis (PrEP) in Australia following nationwide PrEP implementation: an analysis of sentinel surveillance data. Lancet Infectious Diseases, 22(8),1231–1241.

https://pubmed.ncbi.nlm.nih.gov/35643090/
Appendix A: Article about STIs in MSM
Appendix B: Poster Concepts
Appendix C: Online Survey Form