To assess the prevalence of non-AIDS co-morbidities (NACs) and predictors of adverse health outcomes amongst people living with HIV in order to identify health needs and potential gaps in patient management. Retrospective, non-consecutive medical record audit of patients attending a publicly funded HIV clinic in metropolitan Sydney analysed for predictors of adverse health outcomes. We developed a scoring system based on the validated Charlson score method for NACs, mental health and social issues and confounders were selected using directed acyclic graph theory under the principles of causal inference. 211 patient files were audited non-consecutively over 6 weeks. 89.5% were male; 41.8% culturally and linguistically diverse and 4.1% were of Aboriginal/Torres Strait Islander origin. Half of patients had no general practitioner and 25% were ineligible for Medicare subsidised care. The most common NACs were: cardiovascular disease (25%), hepatic disease (21%), and endocrinopathies (20%). One-third of patients had clinical anxiety, one-third major depression and almost half of patients had a lifetime history of tobacco smoking. Five predictors of poor health outcomes were identified: (1) co-morbidity score was associated with hospitalisation (odds ratio, OR 1.58; 95% CI 1.01–2.46; p = 0.044); (2) mental health score was associated with hospitalisation (OR 1.79; 95% CI 1.22–2.62; p = 0.003) and poor adherence to ART (OR 2.34; 95% CI 1.52–3.59; p = 0.001); (3) social issues score was associated with genotypic resistance (OR 2.61; 95% CI 1.48–4.59; p = 0.001), co-morbidity score (OR 1.69; 95% CI 1.24–2.3; p = 0.001) and hospitalisation (OR 1.72; 95% CI 1.1–2.7; p = 0.018); (4) body mass index < 20 was associated with genotypic resistance (OR 6.25; 95% CI 1.49–26.24; p = 0.012); and (5) Medicare eligibility was associated with co-morbidity score (OR 2.21; 95% CI 1.24–3.95; p = 0.007). Most HIV patients are healthy due to effective antiretroviral therapy; however, NACs and social/mental health issues are adding to patient complexity. The current findings underpin the need for multidisciplinary management beyond routine viral load and CD4 count monitoring.

Introduction: Mpox emerged as a multi-country outbreak in 2022 and disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma is known to exacerbate health crises by discouraging testing, treatment, and vaccination. This review aimed to explore stigma associated with Mpox among GBMSM from July 2022, when mpox was declared a public health emergency of international concern. Methods: The PICO framework guided this narrative review. A search was conducted across the following databases from inception to June 2025: PubMed/MEDLINE, Embase, CINAHL, and Web of Science. The literature had to be empirical, peer-reviewed research that focused on mpox-related stigma in GBMSM. Results: Forty-seven studies were included in this review. The following themes were derived: (1) healthcare experiences, (2) media influence, (3) internalised and anticipated stigma, (4) public health messaging, (5) community responses, and (6) psychosocial impact. Healthcare experiences were marked by anticipated discrimination; many GBMSM delayed testing or vaccination for fear of being disclosed or labelled promiscuous. This was especially apparent in contexts where same-sex relationships are criminalised, leading some men to self-medicate or seek clandestine services. Media analyses revealed that social and traditional platforms often amplified blame and homophobia, though community-led counter-messaging helped shift narratives. Internalised and anticipated stigma resulted in shame, concealment of symptoms, avoidance of care, and heightened anxiety. Public health messaging that framed mpox as a behaviour-linked rather than identity-linked risk was more acceptable, and flexible vaccination strategies (e.g., offering less conspicuous injection sites) increased uptake. Stigma contributed to psychosocial distress and may have impeded outbreak control. Conclusions: Mpox-related stigma among GBMSM operates at individual, community, and structural levels, echoing patterns from the HIV era. Effective mitigation requires rights-based, destigmatising communication, culturally competent care, and collaboration. Addressing stigma is vital to controlling future outbreaks and ensuring equitable healthcare access.

Our study aimed to assess cardiovascular risk factor measurements (CVRFM) among people ages ≥40 years attending a sexual health clinic for HIV care before, during, and after scorecard implementation. Scorecards were 1-page visual summaries of risk factor measurement metrics distributed among clinic staff quarterly between November 1, 2022, and October 31, 2023. The median number of yearly risk-factor measurements increased from one in the year before scorecards to three in the year after scorecards. Measurements of systolic blood pressure, total cholesterol:high-density lipoprotein ratio, and glycated hemoglobin increased during the time period; smoking status measurements remained unchanged. Complete risk factor measurements (all four measurements in 1 year) increased from 11% before scorecards to 36% after scorecards. Weight/body mass index measurements and general practitioner linkage increased; having these were also associated with a higher number of other CVRFMs. As a quality-improvement initiative, scorecards may support clinic processes for CVRFM. Further interventions to improve measurement and reduce risk, potentially through sexual health clinic and general practitioner shared care, should be explored.

Syphilis remains a major public health concern globally, with rising incidence contributing to preventable complications, including congenital syphilis. As such, the Western Sydney Local Health District implemented a direct syphilis referral pathway between the public health unit and sexual health services. This study aimed to explore healthcare professionals’ experiences of this direct referral pathway and its perceived impact on clinical outcomes and care coordination. A qualitative study was conducted as part of a quality improvement initiative. Semi-structured interviews were undertaken with clinicians from public health and sexual health services involved in the referral pathway. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive and deductive thematic analysis. Fourteen clinicians participated, including medical practitioners and registered nurses. Two overarching themes were identified: (1) proactive case follow-up as a safeguard against preventable consequences of syphilis and (2) infrastructure and interprofessional relationships as enablers of sustained coordination. Participants reported that the pathway enabled proactive engagement of high-risk populations (i.e., pregnant women), resulting in faster treatment and reduced loss to follow-up. Improved interprofessional communication, clearer roles, and access to digital tools (e.g., shared referral forms and electronic medical records) enhanced coordination. Persistent challenges included stigma, unstable housing, and difficulties engaging some patients despite repeated outreach. Clinicians perceived the direct syphilis referral pathway as improving timeliness, coordination, and equity of care for high-risk patients. Strengthened collaboration between public health and sexual health services supported integrated management, although ongoing social and structural barriers highlight the need for complementary supportive interventions.