Lisa Maher

• PhD
• Senior Researcher at UNSW Sydney

Background Untreated sexually transmissible infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae can lead to serious health issues, including pelvic inflammatory disease, infertility in women, increased HIV risk, and emotional distress. Timely testing and treatment are crucial for reducing transmission. Australia’s STI Manageme...

Background Supervised injecting facilities (SIFs) are designed to reduce the harms associated with injecting drug use and improve access to health and support services for people who need them. The Supervised Injecting Room Cohort Study (SIRX) aims to provide evidence of the effects, including cost-effectiveness, of a SIF embedded within a communit...

Introduction: Some gay and bisexual men who have sex with men (GBMSM) who use drugs to enhance sex (chemsex/party and play) may experience harms and seek talk therapies. GBMSM who practice chemsex may not access drug services because of anticipated stigma and the perception that these services lack chemsex expertise. Barriers to services are docum...

Background During the COVID-19 pandemic, governments worldwide introduced law enforcement measures to deter and punish breaches of emergency public health orders. For example, in Victoria, Australia, discretionary fines of A$1,652 were issued for breaching stay-at-home orders, and A$4,957 fines for ‘unlawful gatherings’; to date, approximately 30,0...

Introduction In Canada, the COVID‐19 pandemic collided with an ongoing overdose crisis driven by a toxic unregulated drug supply. Public health guidance intended to limit transmission of COVID‐19 (e.g., social distancing) directly contradicted guidance responding to the ongoing overdose crisis (e.g., never use drugs alone), exacerbating harms among...

Background Compared to the general population, people who inject drugs have poor health and wellbeing. Longitudinal studies can provide insight into factors driving these worse health outcomes but are subject to methodological challenges, such as cohort attrition. The aim of this study was to assess and characterise attrition in a prospective cohor...

Background To address inequitable diagnostic access and improve time-to-treatment for First Nations peoples, molecular point-of-care (POC) testing for chlamydia, gonorrhoea and trichomonas was integrated into 49 primary care clinics across Australia. We conducted an observational evaluation to determine clinical effectiveness and analytical quality...

Ethnographic-epidemiological (“ethno-epi”) research methodologies are increasingly being used to examine health-related issues, including the experiences of people who use drugs. However, the complementary application of random sampling from a well characterised cohort and qualitative data collection methods in a single study has not been described...

Background Compared to the general population, people who inject drugs have poor health and wellbeing. Longitudinal studies can provide insight into factors driving these worse health outcomes but are subject to methodological challenges, such as cohort attrition. The aim of this study was to assess and characterise attrition in a prospective cohor...

Early neutralizing antibodies against hepatitis C virus (HCV) and CD8 + T cell effector responses can lead to viral clearance. However, these functions alone are not sufficient to protect patients against HCV infection, thus undefined additional antiviral immune mechanisms are required. In recent years, Fc‐receptor‐dependent antibody effector funct...

Introduction Children in families affected by substance use disorders are at high risk of being placed in out‐of‐home care (OOHC). We aimed to describe the characteristics of parents who inject drugs and identify correlates associated with child placement in OOHC. Method s We used baseline data from a community‐based cohort of parents who inject d...

People who inject drugs are at risk of acute bacterial and fungal injecting-related infections. There is evidence that incidence of hospitalizations for injecting-related infections are increasing in several countries, but little is known at an individual level. We aimed to examine injecting-related infections in a linked longitudinal cohort of peo...

The COVID‐19 pandemic triggered widespread socioeconomic hardship, disproportionately impacting disadvantaged populations. People who use illicit drugs are more likely to experience unemployment, homelessness, criminal justice involvement and poorer health outcomes than the general community, yet little is known about the socioeconomic impacts of t...

Importance: Concerns that take-home naloxone (THN) training may lead to riskier drug use (as a form of overdose risk compensation) remain a substantial barrier to training implementation. However, there was limited good-quality evidence in a systematic review of the association between THN access and subsequent risk compensation behaviors. Object...

Early neutralising antibodies against Hepatitis C virus (HCV) and CD8+T cell effector responses can lead to viral clearance. However, these functions alone are not sufficient to protect patients against HCV infection, thus yet undefined additional anti-viral immune mechanisms are required. In recent years, Fc-receptor-dependent antibody effector fu...

Background and aims: Few studies of the impacts of COVID-19 public health measures on drug markets and drug use patterns have used longitudinal data. We aimed to examine whether COVID-19 measures were associated with increases in methamphetamine price, decreases in methamphetamine use frequency, and subsequent changes in secondary outcomes of othe...

Background: The enduring conceptual confusion within drug use literature and research regarding the definition of addiction arises from the lack of reconciliation between two key concepts: (1) addiction occurs when someone loses control over their behaviour, and (2) recovery can only proceed when that individual chooses to regain control. This pape...

Background: Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender. Methods: In this systematic review and meta-analysis, we upd...

Introduction: We aimed to describe COVID-19 vaccination attitudes and identify potential facilitators for vaccine uptake among people who inject drugs. Methods: People who inject drugs were recruited from all eight Australian capital cities (N = 884; 65% male, mean age 44 years) and interviewed face-to-face or via telephone in June-July 2021. CO...

Background and aims: While the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these se...

Background and aims: The 2016 Global Health Sector Strategy (GHSS) on viral hepatitis aims to reduce new hepatitis C virus (HCV) infections by 80% by 2030, including a 30% reduction by 2020. This study aimed to estimate primary HCV incident infection among a national sample of people who inject drugs (PWID) before and after the introduction of unr...

Background & aims: People who inject drugs (PWID) experience high incarceration rates which are associated with increased hepatitis C virus (HCV) transmission risk. We assess the importance of prison-based interventions for achieving HCV elimination among PWID in New South Wales (NSW), Australia. Methods: A model of incarceration and HCV transmi...

Gay, bisexual, and other men who have sex with men (GBM) have developed community norms for regular HIV/STI testing. We investigated factors associated with self-reported COVID-19 testing in response to reported COVID-19 cases and public health restrictions. Participants responded to weekly cohort surveys between 10th May 2021 and 27th September 20...

Successful use of biomedical forms of HIV risk-reduction may have predisposed many gay and bisexual men (GBM) to vaccination against COVID-19, which may, in turn, affect their sexual behavior. A total of 622 Australian GBM provided weekly data on COVID-19 vaccination history and sexual behaviour between 17 January 2021 and 22 June 2021. We identify...

Background: This review aimed to identify hepatitis C virus (HCV) prevalence estimates among the general population and six key populations (people who inject drugs, men who have sex with men, sex workers, prisoners/detainees, Indigenous people, and migrants) in the World Health Organization Western Pacific Region (WHO WPR). Methods: Original re...

Aims: To measure mortality rates and factors associated with mortality risk among participants in the SuperMIX study, a prospective cohort study of people who inject drugs. Design: A prospective observational study using self-reported behavioural and linked mortality data. Setting: Melbourne, Australia. Participants/cases: A total of 1209 pe...

Background People who inject drugs (PWID) may be at elevated risk of adverse outcomes from SARS-CoV-2 infection; however, data on COVID-19 vaccine uptake among PWID are scarce. This study aimed to determine COVID-19 vaccine uptake among PWID, identify factors associated with sub-optimal uptake, and compare uptake to the general population. Methods...

Introduction COVID-19 related lockdowns have impacted the sexual activity of gay and bisexual men (GBM). We investigated trends in sexual behaviors and the COVID-19 context in which they occurred (COVID-notification rates and jurisdictional restrictions) to understand changes in the duration and severity of periods of lockdown on the sexual behavio...

Objectives. To identify key gaps in overdose prevention interventions for mothers who use drugs and the paradoxical impact of institutional practices that can increase overdose risk in the context of punitive drug policies and a toxic drug supply. Methods. Semistructured interviews were conducted with 40 women accessing 2 women-only, low-barrier su...

Objectives. To identify key gaps in overdose prevention interventions for mothers who use drugs and the paradoxical impact of institutional practices that can increase overdose risk in the context of punitive drug policies and a toxic drug supply. Methods. Semi-structured interviews were conducted with 40 women accessing 2 women-only, low-barrier...

The trajectories of people attempting to reduce harmful methamphetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical in...

Although many studies reported on decreases in sexual partner numbers among gay and bisexual-identifying men in the early period of the COVID-19 pandemic, few studies have explored COVID-19 risk-reduction strategies. Drawing on free-text responses in an online survey (from April to July 2020), we describe the ways in which men sought to minimise th...

People who inject drugs may be at higher risk of COVID‐19 transmission and more severe negative health outcomes following COVID‐19 infection. Early research on hypothetical COVID‐19 vaccines suggests this population may be less likely to accept vaccination. This commentary extends this research by presenting vaccine intention data from Illicit Drug...

Although approximately 31,000 Australian gay and bisexual men (GBM) are eligible for HIV pre-exposure prophylaxis (PrEP), only 18,500 people currently use it, indicating a need to investigate why GBM do not use it. This article uses data from a national, online, observational study. It adopts a mixed-methods analysis to responses to survey question...

We examined depression and anxiety prior to and during COVID-19 restrictions in Australian gay and bisexual men (GBM). In an online cohort, a COVID-19-focused survey was conducted in April 2020. During 2019 and in April 2020, 664 GBM completed the Patient Health Questionnaire (PHQ-9, measuring depression) and Generalized Anxiety Disorder Assessment...

Why was the cohort set up? The Melbourne Injecting Drug User Cohort Study (SuperMIX) is an ongoing longitudinal cohort on the natural history of drug use, service use and drug-related harms. SuperMIX is an evolution of the MIX cohort that was established in 2008 to identify trajectories of injection drug use among people who inject drugs (PWID) rec...

Introduction Vaccine acceptability is a key determinant of vaccination uptake. Despite being at risk of adverse outcomes from coronavirus-19 disease (COVID-19), COVID-19 vaccine acceptability among people who inject drugs is unknown. We surveyed people who inject drugs in Melbourne, Australia to assess potential uptake of COVID-19 vaccines prior to...

Background Sexually transmissible infections (STIs), such as gonorrhoea and chlamydia, are highly prevalent, particularly in remote Aboriginal and Torres Strait Islander communities in Australia. In these settings, due to distance to centralised laboratories, the return of laboratory test results can take a week or longer, and many young people do...

Few studies have examined changes in sexual behaviour following HIV pre-exposure prophylaxis (PrEP) initiation among gay, bisexual and other men who have sex with men (GBM) in relationships. In a national, online, prospective study of GBM in Australia, we compared sexual behaviours prior to and after PrEP initiation among HIV-negative and unknown-H...

COVID-19 may threaten the already poor mental health outcomes of Australian gay and bisexual men and cut ties to important social/sexual networks and community. Qualitative research into the experiences of gay and bisexual men during COVID-19 regulations is currently sparse. We report on 489 responses to a qualitative free-text question asking Aust...

The perception of being abnormal, and a visceral desire to ‘feel normal again’, is a common feature of the literature on drug use and recovery. Normality is constructed, however, in response to context-dependent values and priorities, which then legitimate certain behaviours as normative and therefore the assumed goal of people in recovery. In this...

Background: Despite its well documented risks and harms, methamphetamine use can also be experienced as a pleasurable, purposeful, and productive activity. Drug use discourse has historically deemphasised the pleasures of drug use, as they can contradict the expectations of neoliberalism that individuals be moderate, rational consumers. The purpos...

While HIV pre-exposure prophylaxis (PrEP) is highly effective, it has arguably disrupted norms of ‘safe sex’ that for many years were synonymous with condom use. This qualitative study explored the culture of PrEP adoption and evolving concepts of ‘safe sex’ in Sydney, Australia, during a period of rapidly escalating access from 2015–2018, drawing...

The orthodox construction of agency within addiction recovery discourse is built upon a fault line between two conflicting principles: that people who use drugs in harmful ways cannot control their behavior, but that they can also regain that control through intentional effort. The conceptual confusion inherent in this framework can harm people usi...

Background: Previous research has demonstrated how income-generating activities among marginalized people who use drugs (PWUD)-including employment, income assistance, street-based activities, sex work, and illegal activities-can provide both benefit (e.g., additional income) and harm (e.g., violence, criminalization). However, little is known abo...

Introduction Female sexual partners of men who inject drugs (MWID) living with HIV are at risk of HIV transmission. HIV prevalence estimates among non-drug using female sex partners of MWID are scarce, with no studies documenting HIV incidence. We investigated HIV prevalence and incidence among female spouses of MWID registered at Nai Zindagi Trust...

Introduction In 2018, the first Medically Supervised Injecting Room in Melbourne, Australia was officially opened. This study assessed whether this facility attracted people who inject drugs, who were socially vulnerable, and who engaged in drug-related behaviors associated with increased morbidity and mortality risk. Methods This was a cross-sect...

Background People who inject drugs (PWID) living with HIV have poorer adherence to HIV antiretroviral therapy (ART) and elevated mortality compared to other populations. Little is known about factors associated with adherence among PWID in low-and middle-income countries, including in countries where opioid agonist therapy (OAT) is unavailable. We...

Introduction : Sex workers who use drugs represent two distinct populations, yet programmatic and policy responses are siloed and failed to acknowledge the ways in which populations overlap and needs intersect. Although prevalence of drug use among sex workers is believed to be higher than the general population, no published estimates of global pr...

Background Non-fatal overdose (NFOD) is a major cause of morbidity among people who inject drugs (PWID) and multiple NFOD is associated with increased risk of fatal overdose. Despite this, few studies have examined the prevalence and correlates of drug-specific multiple NFOD. The current study aimed to determine the prevalence and correlates of rec...

Background Smoking or inhaling illicit drugs can lead to a variety of negative health outcomes, including overdose. However, most overdose prevention interventions, such as supervised consumption services (SCS), prohibit inhalation. In addition, women are underrepresented at SCS and are disproportionately impacted by socio-structural violence. This...

Background The recent downward revision of the estimated number of people living with chronic hepatitis C in Australia means that the annual number of new hepatitis C infections should also be revised. We aimed to estimate the annual number of new hepatitis C infections among people who inject drugs (PWID) in Australia in 2015, prior to the introdu...

Background People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are st...

Background and aims: Major declines in HIV and hepatitis C and B virus (HCV/HBV) incidence among people who inject drugs (PWID) have been attributed to early implementation of harm-reduction programs (HRP) in the Netherlands, but alternative factors such as selective mortality and demographic and drug market shifts over time probably contributed t...

In a context of ongoing colonization and dispossession in Australia, many Aboriginal people live with experiences of health research that is done “on” rather than “with” or “by” them. Recognizing the agency of young people and contributing to Aboriginal self-determination and community control of research, we used a peer research methodology involv...

Female entertainment and sex workers (FESW) have high rates of alcohol and amphetamine-type stimulant (ATS) use, increasing risk for HIV/sexually transmitted infections (STI), and other negative outcomes. A prospective cohort of 1,198 FESW in a HIV/ATS use prevention intervention in Cambodia was assessed for alcohol and stimulant use disorders (AUD...

The impact of COVID-19 across health services, including treatment services for people who use drugs, is emerging but likely to have a high impact. Treatment services for people who use drugs provide essential treatment services including opiate agonist treatment and needle syringe programmes alongside other important treatment programmes across al...

Female entertainment and sex workers (FESW) are vulnerable to violence, which impedes safer sex behaviors and increases risk of HIV. FESW are also disproportionately affected by co-occurring psychosocial health conditions, including substance use, depression, and economic insecurity, which increased risk of exposure to violence. We used a syndemic...

Introduction Key populations at elevated risk to contract or transmit HIV may also be at higher risk of COVID‐19 complications and adverse outcomes associated with public health prevention measures. However, the conditions faced by specific populations vary according to social, structural and environmental factors, including stigma and discriminati...

Background: In response to the novel coronavirus disease (COVID-19) pandemic, Australia introduced public health and physical distancing restrictions in late March 2020. We investigated the impact of these restrictions on HIV pre-exposure prophylaxis (PrEP) use among Australian gay and bisexual men (GBM). Methods: Participants in an ongoing onli...

Background Monitoring the hepatitis C virus (HCV) cascade of care (CoC) among people who inject drugs (PWID) is an essential component of the response to World Health Organisation's (WHO) hepatitis elimination goals. This study aimed to estimate the Consensus hepatitis C CoC among PWID using data collected in Australia prior to and after the introd...

Background Surveillance data indicate that Aboriginal and Torres Strait Islander young people are more likely than their non-Indigenous counterparts to experience sexually transmissible infections (STIs) and teenage pregnancy. Despite increasing emphasis on the need for strengths-based approaches to Aboriginal sexual health, limited published data...

We report on Australian gay and bisexual men’s (GBM) perceptions of preexposure prophylaxis (PrEP). Drawing on an online longitudinal cohort study, 1,404 free-text responses from HIV-negative or untested Australian GBM were qualitatively analysed. The chi-square statistic was then used to assess differences regarding PrEP-perceptions by participant...

The original version of this article unfortunately contained an error. The authors would like to correct the error with this erratum.

Aims To estimate the prevalence of and risk factors associated with concurrent injection of multiple substances (co‐injection) among a community‐recruited cohort of people who inject drugs. Design Cross‐sectional study. Setting Melbourne, Australia. Participants A sample of 720 actively injecting participants from the Melbourne Injecting Drug Us...

Introduction: In March 2020, Australian state and federal governments introduced physical distancing measures alongside widespread testing to combat COVID-19. These measures may decrease people's sexual contacts and thus reduce the transmission of HIV and other sexually transmissible infections (STIs). We investigated the impact of physical distan...

Background and objectives: Pre-donation screening of potential blood donors is critical for ensuring the safety of the donor blood supply, and donor deferral as a result of risk factors is practised worldwide. This systematic review was conducted in the context of an expert review convened by the Australian Red Cross Lifeblood in 2013 to consider...

Background: As research on HIV vaccines continues to advance, studies exploring the feasibility of this intervention are necessary to inform uptake and dissemination strategies with key populations, including people who use drugs (PWUD). Methods: We conducted 25 in-depth qualitative interviews examining HIV vaccine acceptability among PWUD in Va...

Aims To estimate incidence and predictors of opioid agonist therapy (OAT) discontinuation in a national cohort of people who inject drugs (PWID). Design and Setting Annually repeated cross‐sectional sero‐surveillance among PWID attending ~50 needle syringe programs across Australia. Participants Between 1995‐2018, 2,651 PWID who reported current O...

Purpose To understand the characteristics of a minority of Australian gay and bisexual men (GBM) who, despite an increase in the number and availability of HIV risk reduction strategies, do not consistently use a strategy to protect themselves from HIV. Methods This analysis is based on data from 2,920 participants in a national, online, prospecti...

Use of crystal methamphetamine (crystal) among gay and bisexual men (GBM) has been associated with condomless anal intercourse with casual partners (CLAIC) and HIV infection. Pre-exposure prophylaxis (PrEP) and undetectable viral load (UVL) are important biomedical HIV prevention strategies. We investigate the relationship between crystal use and H...

BACKGROUND Men who have sex with men in Australia are currently ineligible to donate blood (are “deferred”) for 12 months since last oral or anal sexual contact with another man. In Australia and overseas, there has been limited research on attitudes and perceptions related to blood donation in this population. STUDY DESIGN AND METHODS Questions o...

Background: Australian surveillance data document higher rates of sexually transmissible infections (STIs) among young Aboriginal people (15-29 years) in remote settings than non-Aboriginal young people. Epidemiological data indicate a substantial number of young Aboriginal people do not test for STIs. Rigorous qualitative research can enhance und...

Background Attention to how women are differentially impacted within harm reduction environments is salient amidst North America's overdose crisis. Harm reduction interventions are typically ‘gender-neutral’, thus failing to address the systemic and everyday racialized and gendered discrimination, stigma, and violence extending into service setting...

The Indigenous Resiliency Participatory Action Research (IR PAR) project is one of four components of a collaborative project being conducted by Townsville Aboriginal and Islander Health Service, Derbarl Yerrigan Aboriginal Health Service, Perth, the Aboriginal Medical Service, Redfern and the National Centre in HIV Epidemiology and Clinical Resear...

Engagement in prevention services is crucial to reducing HIV risk among female entertainment and sex workers (FESW), and SMARTgirl is the national social marketing HIV prevention program for Cambodian women engaged in sex and entertainment work. Informed by the Behavioral Model of Vulnerable Populations, three multivariate logistic regression analy...

Background and objectives: Until recently, people in Australia with a history of injection drug use (IDU) were deferred indefinitely from donating blood. Knowledge gaps regarding policy non-compliance and the prevalence of blood donation practices amongst people who inject drugs (PWID) precluded changes to this policy. We sought to address these g...

Background and aims: Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for popp...

Background: Remote Australian Aboriginal communities have among the highest diagnosed rates of sexually transmissible infections (STIs) in the world. We did a trial to assess whether continuous improvement strategies related to sexual health could reduce infection rates. Methods: In this stepped-wedge, cluster-randomised trial (STIs in remote co...

Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct‐acting antiviral (DAA) treatment. Participants enrolled in an observational cohort...

Background and aims: Neutralising antibodies (NAb) play a key role in clearance of hepatitis C virus (HCV). NAbs have been isolated and mapped to several domains on the HCV Envelope proteins. However, the immunodominance of these epitopes in HCV infection remains unknown, hindering vaccine efforts to elicit optimal epitope-specific responses. Furt...

Background: Many gay and bisexual men (GBM) experience HIV anxiety, particularly around condomless anal intercourse. HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that may reduce HIV anxiety among GBM. Methods: The Following Lives Undergoing Change (Flux) Study is a national, online, open-prospective observational s...

Hepatitis C virus (HCV) is one of very few viruses that are either naturally cleared, or alternatively persist to cause chronic disease. Viral diversity and escape, as well as host adaptive immune factors, are believed to control the outcome. To date, there is limited understanding of the critical, early host-pathogen interactions. The asymptomatic...