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Fiji has been reporting a significant rise in the incidence of Human immunodeficiency (HIV) and hepatitis C virus (HCV) over the last 3 years.  Health officials estimate that about 9,000 people are living with HIV in Fiji today, nearly 1% of the population. A startling 2,016 new cases of HIV alone were reported in 2025, compared to 1,583 cases in 2024. Among people starting HIV treatment in 2024, 48% were people who inject drugs, highlighting the disproportionate impact on this group, and unsafe injecting drug use being the major driver of transmission, exposing urgent gaps in access to prevention and stigma-free care. In addition, an estimated 59 infants were born with HIV in 2025, up from 31 in 2024, demonstrating the spread of HIV through sexual transmission and from birthing parent to child. There are limited epidemiological data available on HCV in Fiji but it's sharp rise has also been observed. Links: Fiji strengthens its HIV response through evidence-based harm reduction Fiji’s HIV Epidemic Escalates Strengthening Fiji’s HIV response through shared expertise and regional collaboration Participants: Host: Ass Prof/Dr Fabiola Martin, Canberra Sexual Health Centre and Australian National University, Canberra, Australia Dr Jason Mitchell, Lead of the SRH and HIV Unit at Ministry of Health and Medical Services and Chairperson of the National HIV Outbreak and Cluster Response Taskforce in Fiji

The experience of treating and/or losing a patient to anal cancer is deeply upsetting. Therefore, the early detection and treatment of precursors are of utmost importance to patients and clinicians. People with HIV have a higher prevalence and incidence of Human Papilloma Virus infection, an oncogenic virus, which may cause intraepithelial neoplasia, the precursor of squamous cell carcinomas in the anal canal. Though encouraging progress has been made to support gay and bisexual men and transgender women with HIV from developing anal cancer, research and health policies do not offer specific prevention strategies against anal cancer in people assigned female at birth. In this podcast Dr Tamzin Cuming outlines progress made so far and areas of research and health care that need further attention.   Links: https://iansoc.org/Board-of-Directors   Host: Ass. Prof./Dr. Fabiola Martin, BMJ STI Podcast Editor, Sexual Health and HIV Specialist, Clinical Associate Professor, Australian National University, Canberra, Australia Guest: Dr Tamzin Cuming, Consultant Colorectal Surgeon, President of International Anal Neoplasia Society, Homerton Hospital, in London, UK

Previously we reported on the Rise of Syphilis world wide. Today we focus on the devastating effects of syphilis on parents and their children. Hand in hand with an increase in syphilis incidence in adults the rates of congenital syphilis are rising and missed opportunities to test and treat birthing parents, their partners and babies are preventable contributing factors. Congenital syphilis is caused by Treponema pallidum transmission to the foetus during pregnancy and birth, resulting in diverse clinical presentations. Congenital syphilis in a foetus may be associated with a full-term, seemingly healthy infant, but it can also cause multi-organ dysfunction, prematurity, and/or stillbirth. Routine screening and early treatment of pregnant people affected by syphilis is the hallmark of effective intervention to decrease infant morbidity and mortality. Host: Ass Prof/Dr Fabiola Martin, Canberra Sexual Health Centre and Australian National University, Canberra, Australia Guests: - Professor Clare Nourse, Member of the Order of Australia, a paediatric infection specialist at the Queensland Children’s Hospital and clinical professor of paediatrics at the University of Queensland - Dr Justin Penner, Consultant in paediatric infectious diseases at Imperial College NHS Healthcare Trust, London, UK and Honorary Senior Lecturer, Imperial College London

Continuing on the search for innovative strategies to shape the future of HIV cure research in the second part of this series, Dr Jillian Lau discusses how anti–PD1 immunotherapies and carefully designed treatment interruption studies are helping clinicians and scientists to better understand pathways to durable HIV remission. Dr Ming Lee then breaks down the results of the RIO study, highlighting the promising potential of broadly neutralising antibodies (bNAbs) in sustaining viral control without ongoing therapy. Together, they offer a forward-looking perspective on the scientific breakthroughs moving us closer to an HIV cure. Listen to part 1 of this podcast: Apple: https://podcasts.apple.com/us/podcast/world-aids-day-pt-1-progress-towards-an-hiv-cure/id356342980?i=1000739054089&uo=4 Spotify: https://open.spotify.com/episode/73LY8Eie8EQ7I5FKF6F0SM Web: https://stibmj.podbean.com/e/world-aids-day-pt-1-progress-towards-an-hiv-cure/  Links: Sustained HIV-1 remission after heterozygous CCR5Δ32 stem cell transplantation Host: Dr Ming Lee, Sexual Health Specialist, Canberra Sexual Health Centre, ACT, Australia; Honorary Clinical Senior Lecturer, Imperial College London, London, UK   Guests:  - Professor Christian Gaebler, Professor, Charité Universitätsmedizin Berlin, Berlin, Germany - Professor Beatriz Mothe, Group Leader and Senior Research Scientist, IrsiCaixa, Barcelona, Spain - Dr Jillian Lau, Infectious Disease Physician and Post doctoral Research Fellow, Department of Infectious Diseases, University of Melbourne and the Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia

In the first of this two-part series, we explore the latest advances in the search for an HIV cure. Professor Christian Gaebler shares insights from the remarkable case of the second Berlin patient —an individual cured of HIV following a stem cell transplant—and reflects on what similar cases mean for the future of curative strategies. We’re also joined by Professor Beatriz Mothe, who discusses the promise of therapeutic vaccines and their role in long-term HIV remission, and the results of the AELIX003 study.  Links: Sustained HIV-1 remission after heterozygous CCR5Δ32 stem cell transplantation Host: Dr Ming Lee, Sexual Health Specialist, Canberra Sexual Health Centre, ACT, Australia; Honorary Clinical Senior Lecturer, Imperial College London, London, UK   Guests:  - Professor Christian Gaebler, Professor, Charité Universitätsmedizin Berlin, Berlin, Germany - Professor Beatriz Mothe, Group Leader and Senior Research Scientist, IrsiCaixa, Barcelona, Spain - Dr Jillian Lau, Infectious Disease Physician and Post doctoral Research Fellow, Department of Infectious Diseases, University of Melbourne and the Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia

Over the last decade we have seen an exponential surge in research and peer reviewed publications about the sexual health of trans and gender diverse people. We now know that sexually transmitted infections are highly prevalent in this key population and there is an urgent need for concentrated efforts made by patient advocates, health care providers, public health policy developers and governments to improve health and prevent harm in this underserved population. Today we discuss with Prof Jade Ghosn, his team's latest publication in STI BMJ titled: "Pre-exposure prophylaxis (PrEP) uptake and retention in care in a group of transgender women at high risk of HIV: a French cohort of follow-up" and with Alisha Goburdhun, her team's work in supporting and advocating for trans clients at Accpetess-T.   Host: Ass Prof/Dr Fabiola Martin, Sexual health Specialist, Canberra Sexual Health Centre, Australian National University ‌ Guests: Alisha Goburdhun, Heath Mediator at Acceptess-T, Paris, France Prof Jade Ghosn, Infectious Diseases Specialist at the Sexual Health Clinic in Bichat University Hospital in Paris, France

Most people requiring HIV pre-exposure prophylaxis (PrEP) are offered a daily or event driven oral tablet which contains two HIV antiretroviral drugs combined. Oral medication, however, may not be a feasible and/or effective PrEP option for some. FDA has approved two long-acting injectable HIV anti-viral drugs: Cabotegravir, an HIV integrase inhibitor (2 monthly injections) and Lenacapavir an HIV capsid inhibitor (6 monthly injections) as safe and efficacious HIV PrEP. Today we will discuss the efficacy of and access to long-acting HIV PrEP with Prof Sinead Delany-Moretlwe and Dr Claire Dewsnap.   STI has published extensively on the topic, here are a few examples of recent articles: Pre-exposure prophylaxis (PrEP) uptake and retention in care in a group of transgender women at high risk of HIV: a French cohort of follow-up Association between HIV risk perception, knowledge of biomedical prevention and sexual behaviour among sub-Saharan African immigrants living in a precarious situation in France Preferences for pre-exposure prophylaxis service package among men who have sex with men in Australia: a discrete choice experiment Estimating the number of people who could benefit from HIV pre-exposure prophylaxis (PrEP) in England and the unmet need Regression-based risk scores using sociodemographic and sexual behaviour data do not predict asymptomatic sexually transmitted infections among HIV PrEP users   Host: Ass Prof/Dr Fabiola Martin, Sexual Health Specialist, Associate Professor at Australian National University Guests: Prof Sinead Delany-Moretlwe, Professor of Global Health and Infectious Diseases at the University of the Witwatersrand, Johannesburg Dr Claire Dewsnap, President of the British HIV Association for HIV & Sexual Health (BASHH) and Consultant in Genitourinary Medicine, Sheffield Teaching Hospital, Sheffield, UK

Worldwide the prevalence of sexually transmitted infections is increasing. Today we will discuss innovative ways of testing and treating large number of patients with STIs that are equitable, reliable and potentially cost-effective. We will discuss the eSexual Health Clinic (eSHC) research published in The Lancet Public Health in 2017 and NIHR funded  SEQUENCE Digital research program based in UK as well as the multi-site co-designed EmERGE research program based in UK, Croatia and Zambia. Host: Ass Prof/Dr Fabiola Martin, Sexual Health Specialist, Associate Professor at Australian National University Guests: Professor Claudia Estcourt, Professor of Sexual Health & HIV in Glasgow, Scotland and in London and a sexual health clinician Dr Mary Darking, Principal Lecturer in Social Policy and Innovation at Brighton University Lancet paper: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30034-8/fulltext

Today we will discuss the evolution and efficacy of antenatal testing for blood borne pathogens as a strategy to improve pregnancy outcomes and prevent parent to child transmission. Over the last 40 years the number of infections tested for in the antenatal setting has expanded which has been followed closely by treatment guidelines for each infection. However, there are stark regional differences in the infections routinely tested for. Brazil has recently added Human T Leukaemia Virus (HTLV) to its antenatal testing and is planning to test 2.5 million pregnancies yearly. Pregnant people who test positive for HTLV are advised to avoid breast feeding and are provided with formula milk free of charge. Health care providers are being offered upskilling in HTLV care provision. This way Brazil aims to "Take HTLV out of Invisibility" and ultimately eliminate HTLV in Brazil. Host: Ass Prof/Dr Fabiola Martin, Sexual Health Specialist, Associate Professor at Australian National University Guests: Professor Graham Taylor, Head of Section of Virology at Imperial College London and a founder of the National Centre for Human Retrovirology at St. Mary’s Hospital – the UK’s clinical service for people living with Human T Leukaemia Virus (HTLV) infection. Dr Pâmela Cristina Gaspar, General Coordinator of Sexually Transmitted Infections Surveillance at Ministry of Health of Brazil, Brasilia, Brazil Host: Ass Prof/Dr Fabiola Martin, Sexual health, HIV and HTLV Specialist, Canberra, Australia and Australian National University   Brazil HTLV ANC testing: - National guide: https://www.gov.br/aids/pt-br/central-de-conteudo/publicacoes/2022/guia_htlv_internet_24-11-21-2_3.pdf/view   - Folder HTLV for general population: https://www.gov.br/aids/pt-br/assuntos/ist/materiais-informativos/folder-htlv-final-grafica.pdf  - Distance Learning Course for HTLV: https://campusvirtual.fiocruz.br/gestordecursos/hotsite/htlv    NACCHO-ASHM, Australia, HTLV testing guidelines: https://htlv1.guidelines.org.au/

Today we will discuss different types of HIV and Syphilis antibody testing performed at home by the patient or consumer. Home testing for HIV and Syphilis empower people, especially pregnant women who live in remote areas or are marginalised and hard to reach, to screen themselves for these two serious and communicable infections at home and seek additional confirmitory testing, treatment and support if their screening test is reactive. We will discuss what these tests are, how they can be used as well as review their merits and potential risks. Host: Dr Fabiola Martin, Sexual Health Specialist, Associate Professor at Australian National University Guest: Dr Bobbie Van Der Pol, Professor of Medicine and Public Health at the University of Alabama at Birmingham, the Director of the UAB STD Diagnostics Laboratory and President of the International Society for STD Research.

Today we will discuss if screening asymptomatic Men who have sex with Men, also referred to as MSM, who are receiving HIV pre-exposure anti-retroviral medication, called HIV PrEP, routinely for bacterial STIs, gonorrhoea and chlamydia through pharyngeal, urine and rectal PCR testing every three months- also referred to as 3x3 testing is indeed of benefit or may cause harm. This year, in Lancet HIV, the Gonoscreen trial, a randomised controlled trial, of 500 MSM on PrEP in each arm followed up for 12 months reported that 3x 3 testing does not reduce the incidence of gonorrhoea and chlamydia infections in this specific cohort. In Belgium, this trial has led to a change in clinic practice through the Belgium HIV PrEP guidelines where patients will be screened less frequently and intensely. Lancet ID on the other hand published an opinion piece by Raccagni et al where concerns about transmission and morbidity risk of untreated infection and implications of using poor quality screening tools are voiced. We will discuss today the merit of the Gonoscreen trial and other studies that support a decrease in screening & treating asymptomatic bacterial STIs and exercising stricter antimicrobial stewardship versus the risks associated with leaving asymptomatic infections untreated and risking morbidity and transmission. Relevant links: Effect of screening for Neisseria gonorrhoeae and Chlamydia trachomatis on incidence of these infections in men who have sex with men and transgender women taking HIV pre-exposure prophylaxis (the Gonoscreen study): results from a randomised, multicentre, controlled trial Primum non-nocere: Is it time to stop screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men taking HIV pre-exposure prophylaxis? The arrested immunity hypothesis in an immunoepidemiological model of Chlamydia transmission Gonorrhoea and chlamydia screening for asymptomatic people with HIV and HIV PrEP users: open issues Host: Dr Fabiola Martin, Sexual Health Specialist and Associate Professor, Australian National University, Canberra, Australia Dr Thibaut Vanbaelen, physician and post-doctoral researcher at The Institute of Tropical Medicine in Antwerp, Belgium Dr Angelo Roberto Raccagni, physician at Vita-Salute San Raffaele University in Milan, Italy

Today we provide you with an update on the sexually transmitted infection: Trichomonas vaginalis, a protozoan which infects the vagina, urethra and paraurethral glands. It is an uncommon cause of vaginal discharge and penile urethritis and can persist for a long time if left untreated. Up to 50% of people with vaginal infections and especially people with urethral infections remain asymptomatic. Persistent trichomonas infection has been associated with facilitating the transmission of human immunodeficiency virus (HIV) and adverse poor reproductive health outcomes. Dr Christina Muzny, Professor in Infectious Diseases at University of Alabama, Birmingham, USA, will present on published clinical trial data on novel treatment against trichomoniasis. Relevant publications: Van Gerwen OT, Aaron KJ, Schroeder J, et al. Spontaneous resolution of Trichomonas vaginalis infection in men. Sexually Transmitted Infections. Published Online First: 27 June 2024. doi: 10.1136/sextrans-2024-056160. Muzny CA, Van Gerwen OT, Kaufman G, Chavoustie S. Efficacy of single-dose oral secnidazole for the treatment of trichomoniasis in women co-infected with trichomoniasis and bacterial vaginosis: a post hoc subgroup analysis of phase 3 clinical trial data. BMJ Open. 2023;13:e072071 Kissinger PJ, Gaydos CA, Seña AC, McClelland RS, Soper, Secor WE, Legendre D, Workowski KA, Muzny CA, Diagnosis and Management of Trichomonas vaginalis: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines, Clinical Infectious Diseases, Clinical Infectious Diseases, Volume 74, Issue Supplement_2, 15 April 2022 Howe K and Kissinger PJ. Single-dose compared with multidose metronidazole for the treatment of trichomoniasis in women: a meta-analysis. Sex Transm Dis 2017; 44: 29–34. Kissinger P, Muzny CA, Mena LA, et al. Single-dose versus 7- day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial. Lancet Infect Dis 2018; 18: 1251–1259. Sherrard J, Pitt R, Hobbs KR, Maynard M, Cochrane E, Wilson J, Tipple C. British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021. Int J STD AIDS. 2022 Jul;33(8):740-750. STI Guidelines Australia - Trichomoniasis Host: Dr Fabiola Martin, STI BMJ Podcast editor, a Sexual Health, HIV and HTLV Specialist, Canberra & University of Queensland, Brisbane, Australia Guest: Dr Christina Muzny, Professor in Infectious Diseases at University of Alabama, Birmingham, USA

You will recall a previous podcast about preventing Neisseria gonorrhoea through an effective vaccine. Neisseria gonorrhoeae is a ubiquitous sexually transmitted bacteria that can cause both localised and systemic disease if left untreated. It may be transmitted to neonates. We also reported on a rise of the gonorrhoea incidence, as well as increasing rates of antibiotic resistance. Today we will revisit the implementation of vaccinations against gonorrhoea in the UK. Here is an exciting up-date on the advice provided by UK's Joint Committee on Vaccination and Immunisation, JCVI, on using the vaccine 4CMebB OMV against Meningococcus used off-label for the prevention of gonorrhoea infection • in patients at significant risk of infection with bacterial STIs who • attend specialist sexual health services. Host: Dr. Fabiola Martin, Sexual Health HIV, HTLV Specialist, Canberra Sexual Health Services & University of Queensland, Australia Participants: Dr. Suneeta Soni, Consultant in Sexual Health and HIV, University Hospitals Sussex and Chair of the Bacterial special interest group for BASHH *British Association for Sexual health and HIV) Dr. Yen Bui, Consultant in Vaccination and Travel Health, Institut national de santé publique du Québec, Canada A/P. Dr. Kate Seib, NHMRC Leadership Fellow and Associate Director for Research, Institute for Glycomics, Griffith University, Australia

Today we will focus on the alternative treatments of early Syphilis. Worldwide many of us have experienced a shortage of gold standard treatment benzathine benzylpenicillin injections for syphilis. It is time we look for alternative antibiotic treatments and prevention strategies for syphilis. In conversation with Prof Jeffery Klausner, Professor of Medicine, Infectious Diseases and Public Health at the Keck School of Medicine of the University of Southern California, we will discuss a new study published in the Lancet in 2024. Mitja O. et al compared oral linezolid with benzathine penicillin G for treatment of early syphilis in adults (Trep-AB Study) in Spain, which is a prospective, open-label, non-inferiority, randomised controlled trial. Acknowledgement for his valuable contributions to the content of the podcast: Dr Oriol Mitjà, Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fundació Lluita Contra les Infeccions, Barcelona, Spain. Related link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00683-7/fulltext

In our final episode in honour of the World AIDS Day we have a conversation with Assistant Prof. Rajasuriar, who coordinates the translational research program in HIV immunology and Ageing at the Centre of Excellence for Research in AIDS (CERiA) in Kuala Lumpur, Malaysia. Today, thanks to effective HIV antiretroviral therapy, people living with HIV can live long and healthy lives. According to the latest data from the Centers for Disease Control and Prevention (CDC), in 2021, of the nearly 1.1 million people living with diagnosed HIV in the United States and dependent areas, over 53% were aged 50 or older. Hosted by: Dr Fabiola Martin, the BMJ STI Podcast editor and Sexual Health Specialist based in Australia and Senior Clinical Lecturer at School of Public Health at University of Queensland. Growing older with HIV in the Treat-All Era Reena Rajasuriar 1 , Heidi M Crane 2 , Aggrey S Semeere 3 PMID: 36176021 PMCID: PMC9522984 DOI: 10.1002/jia2.25997 https://onlinelibrary.wiley.com/doi/10.1002/jia2.25997  Integrated care for older people (‎ICOPE)‎: guidance for person-centred assessment and pathways in primary care https://www.who.int/publications-detail-redirect/WHO-FWC-ALC-19.1