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Projecting the sexual minority population: Methods, data, and illustrative projections for Australia. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.45.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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McManus H, Callander D, Asselin J, McMahon J, Hoy JF, Templeton DJ, Fairley CK, Donovan B, Pedrana AE, Keen P, Wilson DP, Elliott J, Kaldor J, Liaw ST, Petoumenos K, Holt M, Hellard ME, Grulich AE, Carr A, Stoove MA, Guy RJ. A New Method for Estimating the Incidence of Infectious Diseases. Am J Epidemiol 2021; 190:1386-1395. [PMID: 33534904 DOI: 10.1093/aje/kwab014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/14/2022] Open
Abstract
Ambitious World Health Organization targets for disease elimination require monitoring of epidemics using routine health data in settings of decreasing and low incidence. We evaluated 2 methods commonly applied to routine testing results to estimate incidence rates that assume a uniform probability of infection between consecutive negative and positive tests based on 1) the midpoint of this interval and 2) a randomly selected point in this interval. We compared these with an approximation of the Poisson binomial distribution, which assigns partial incidence to time periods based on the uniform probability of occurrence in these intervals. We assessed bias, variance, and convergence of estimates using simulations of Weibull-distributed failure times with systematically varied baseline incidence and varying trend. We considered results for quarterly, half-yearly, and yearly incidence estimation frequencies. We applied the methods to assess human immunodeficiency virus (HIV) incidence in HIV-negative patients from the Treatment With Antiretrovirals and Their Impact on Positive and Negative Men (TAIPAN) Study, an Australian study of HIV incidence in men who have sex with men, between 2012 and 2018. The Poisson binomial method had reduced bias and variance at low levels of incidence and for increased estimation frequency, with increased consistency of estimation. Application of methods to real-world assessment of HIV incidence found decreased variance in Poisson binomial model estimates, with observed incidence declining to levels where simulation results had indicated bias in midpoint and random-point methods.
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Wilson T, Temple J, Lyons A, Shalley F. What is the size of Australia's sexual minority population? BMC Res Notes 2020; 13:535. [PMID: 33198795 PMCID: PMC7670686 DOI: 10.1186/s13104-020-05383-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/10/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives The aim is to present updated estimates of the size of Australia’s sexual minority adult population (gay, lesbian, bisexual, and other sexual minority identities). No estimate of this population is currently available from the Australian Bureau of Statistics, and very little is available from other sources. We obtained data on sexual minority identities from three data collections of two national surveys of recent years. Combining averaged prevalence rates from these surveys with official Estimated Resident Population data, we produce estimates of Australia’s sexual minority population for recent years. Results According to percentages averaged across the three survey datasets, 3.6% of males and 3.4% of females described themselves with a minority sexual identity. When applied to Estimated Resident Populations, this gives a sexual minority population at ages 18 + in Australia of 599,500 in 2011 and 651,800 in 2016. Population estimates were also produced by sex and broad age group, revealing larger numbers and higher sexual minority percentages in the younger age groups, and smaller numbers and percentages in the oldest age group. Separate population estimates were also prepared for lesbian, gay, bisexual, and other sexual minority identities.
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Affiliation(s)
- Tom Wilson
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Jeromey Temple
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Fiona Shalley
- Northern Institute, Charles Darwin University, Darwin, NT, Australia
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Mauck DE, Gebrezgi MT, Sheehan DM, Fennie KP, Ibañez GE, Fenkl EA, Trepka MJ. Population-based methods for estimating the number of men who have sex with men: a systematic review. Sex Health 2020; 16:527-538. [PMID: 31658435 DOI: 10.1071/sh18172] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/16/2019] [Indexed: 11/23/2022]
Abstract
The objective of this systematic review was to summarise population-based methods (i.e. methods that used representative data from populations) for estimating the population size of men who have sex with men (MSM), a high-risk group for HIV and other sexually transmissible infections (STIs). Studies using population-based methods to estimate the number or percentage of MSM or gay men were included. Twenty-eight studies met the inclusion criteria. Seven studies used surveillance data, 18 studies used survey data, and six studies used census data. Sixteen studies were conducted in the US, five were conducted in European countries, two were conducted in Canada, three were conducted in Australia, one was conducted in Israel, and one was conducted in Kenya. MSM accounted for 0.03-6.5% of men among all studies, and ranged from 3.8% to 6.4% in the US, from 7000 to 39100 in Canada, from 0.03% to 6.5% in European countries, and from 127947 to 182624 in Australia. Studies using surveillance data obtained the highest estimates of the MSM population size, whereas those using survey data obtained the lowest estimates. Studies also estimated the MSM population size by dimensions of sexual orientation. In studies examining these dimensions, fewer people identified as MSM than reported experience with or attraction to other men. Selection bias, differences in recall periods and sampling, or stigma could affect the estimate. It is important to have an estimate of the number of MSM to calculate disease rates, plan HIV and STI prevention efforts, and to allocate resources for this group.
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Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; and Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Eric A Fenkl
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL 33199, USA; and Corresponding author.
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Martín-Sánchez M, Fairley CK, Bradshaw CS, Chen MY, Chow EPF. Meningococcal vaccine uptake among men who have sex with men in response to an invasive meningococcal C disease outbreak in Melbourne, Australia. Sex Transm Infect 2020; 96:246-250. [DOI: 10.1136/sextrans-2019-054318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 11/03/2022] Open
Abstract
ObjectiveIn 2017, there was an outbreak of invasive meningococcal disease (IMD) serogroup C among men who have sex with men (MSM) in Victoria, Australia. A government-funded free meningococcal (MenACWY) vaccination programme targeting all MSM living in Victoria was launched between December 2017 and December 2018. The aim of this study was to examine the vaccine uptake among MSM attending a sexual health clinic in Melbourne.MethodsThis was a retrospective clinical audit of MSM attending the Melbourne Sexual Health Centre (MSHC) during the vaccination programme. We calculated the proportion of MSM who received the meningococcal vaccine on their first visit and at any time during the programme. We performed univariable and multivariable logistic regression to identify the factors associated with the vaccine uptake on the first visit.ResultsOf the 10 370 MSM who attended MSHC, 55.5% received the vaccine on their first visit and 67.4% at any time during the programme. MSM had higher odds of receiving the vaccine on the first visit if they were aged 16–25 years (adjusted OR (aOR) 1.21; 95% CI 1.08 to 1.35) or 26–35 years (aOR 1.17; 95% CI 1.07 to 1.29) in comparison with MSM older than 35 years; were HIV-negative and not on pre-exposure prophylaxis (aOR 1.80; 95% CI 1.56 to 2.09); had more than four male partners in the last 12 months (aOR 1.16; 95% CI 1.06 to 1.27); had male partners only (aOR 2.24; 95% CI 1.96 to 2.55); or were born overseas (aOR 1.11; 95% CI 1.03 to 1.21).ConclusionsTwo-thirds of the MSM attending a sexual health clinic received at least one dose of meningococcal vaccine. The vaccination programme coincided temporally with a dramatic reduction in the incidence of IMD. Vaccination should be further promoted among MSM and men who have sex with both men and women.
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Ooi C, Kong FYS, Lewis DA, Hocking JS. Prevalence of sexually transmissible infections and HIV in men attending sex-on-premises venues in Australia: a systematic review and meta-analysis of observational studies. Sex Health 2020; 17:135-148. [PMID: 32228828 DOI: 10.1071/sh19150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022]
Abstract
Background In Australia, men who have sex with men (MSM) have high rates sexually transmissible infections (STIs) and sex-on-premises venue (SOPV) patrons are at risk. This paper assesses Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis and HIV prevalence in men tested at Australian SOPVs and describes testing services. METHODS EMBASE, Medline, PubMed and international conference proceedings were searched for articles reporting on-site SOPV testing between 1 January 2000 and 31 January 2017. Meta-analysis calculated pooled prevalence estimates of STIs by anatomical site. RESULTS Twelve cross-sectional studies were identified. Most (8/12) were local sexual health clinics (SHC) outreach services. Participants' mean age was 41.1 years (95% confidence interval (CI) 37.0-43.3; range 17 to 84 years). Testing included CT and NG (9/12), HIV (8/12) and syphilis (5/12). CT and NG prevalence overall summary estimates were 3.4% (95% CI 1.9-5.2%, I2 = 88.7%, P < 0.01) and 1.3% (95% CI 0.7-2.2%, I2 = 75.5%, P < 0.01) respectively. CT and NG prevalence was highest in the ano-rectum and oro-pharynx respectively. The HIV and syphilis pooled estimates were 2.3% (95% CI 1.6-2.9%, I2 = 93.1%, P < 0.01) and 3.2% (95% CI 1.8-4.6%, I2 = 72.8%, P < 0.01) respectively. Participation rate varied. CONCLUSION This review examines HIV and STI testing in Australian SOPVs before HIV pre-exposure prophylaxis (PrEP). Findings indicate a high prevalence of STIs. PrEP use and resultant condomless sex may influence STI prevalence. Further research is required to determine the effect of PrEP on the STI prevalence among SOPV patrons.
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Affiliation(s)
- Catriona Ooi
- Clinic 16, 2C Herbert Street, St Leonards, NSW 2065, Australia; and Northern Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW 2006, Australia; and Corresponding author.
| | - Fabian Y S Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Parkville, Vic. 3010, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, 162 Marsden Street, Parramatta, NSW 2150, Australia; and Westmead Clinical School, Faculty of Health and Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Darcy Road, Westmead, NSW 2145, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Parkville, Vic. 3010, Australia
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Choi EPH, Wong JYH, Fong DYT. Disparities Between HIV Testing Levels and the Self-Reported HIV-Negative Status of Sexually Active College Students. JOURNAL OF SEX RESEARCH 2019; 56:1023-1030. [PMID: 30526085 DOI: 10.1080/00224499.2018.1541961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The methodological issues of using self-reported human immunodeficiency virus (HIV) testing history to determine HIV infection status are understudied. This study aimed to assess the disparities between HIV testing history and self-reported HIV status, with a specific objective of estimating the prevalence of self-reported HIV-negative status in sexually active students who had never had an HIV test (inaccurate self-disclosure). Participants were recruited from four Hong Kong universities; 255 students were included in the analysis, with 16.1% of participants being men who have sex with men (MSM). Overall, 81.6% of participants reported they never had been tested for HIV, with inaccurate self-disclosure by 65.9% of participants. Among participants who used condoms inconsistently, only 20.2% had had HIV tests, with inaccurate self-disclosure by 66.7% of subjects. Among MSM students, only 36.6% had had HIV tests, with inaccurate self-disclosure by 61.0% of participants. Among MSM students who used condoms inconsistently, only 35.1% had had HIV tests, with inaccurate self-disclosure by 62.2% of participants. The findings raise concerns about the use of self-reported HIV status in clinical practice and research. The low prevalence of HIV testing found suggests that interventions to promote HIV testing should be continued.
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Down I, Prestage G, Brown G, Ellard J, Guy R, Hellard M, Wilson D, de Wit J, Stoové M, Holt M. Comparing Australian gay and bisexual men with undiagnosed and recently diagnosed HIV infection to those in the National HIV Registry. Sex Health 2019; 15:276-281. [PMID: 29506641 DOI: 10.1071/sh17064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/17/2017] [Indexed: 11/23/2022]
Abstract
Background Gay and bisexual men (GBM) with recent HIV infection are a key population to inform HIV-prevention. The National HIV Registry (NHR) provides details about all individuals diagnosed with HIV, but it is unclear how. METHODS Basic sociodemographic characteristics of GBM in the NHR who were diagnosed between 2010 and 2014 were compared with three samples of GBM: men with undiagnosed HIV infection from the Community-Based Study of Undiagnosed HIV and Testing (COUNT) study of HIV prevalence and undiagnosed infection that was conducted during 2013-14; men in the Australian Gay Community Periodic Surveys (GCPS) who were diagnosed with HIV between 2010 and 2014; and men in the HIV Seroconversion Study (SCS) who were also diagnosed in those years. RESULTS The NHR identified 3629 men who reported male-to-male sex as the exposure risk for their diagnosis between 2010 and 2014. COUNT identified 19 (8.9% of all men who tested HIV positive) men as having undiagnosed HIV. In the GCPS sample, 185 (2.5%) reported being diagnosed with HIV in 2010-14. In total, 367 men in the SCS received their diagnosis during 2010-14. The mean age of men in the NHR (36.8 years) was similar to that in GCPS (36.3 years) and SCS (35.1 years), while undiagnosed men in COUNT were younger (32.6 years), with no other significant differences between the samples. CONCLUSIONS The undiagnosed men were somewhat younger than diagnosed men. To achieve earlier diagnosis of new HIV infections, improved HIV testing frequency is needed among younger men.
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Affiliation(s)
- Ian Down
- Kirby Institute, UNSW Sydney, NSW 1466, Australia
| | | | - Graham Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Vic. 3086, Australia
| | - Jeanne Ellard
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Vic. 3086, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, NSW 1466, Australia
| | - Margaret Hellard
- The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - David Wilson
- Kirby Institute, UNSW Sydney, NSW 1466, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Sydney, NSW 1466, Australia
| | - Mark Stoové
- The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Martin Holt
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Vic. 3086, Australia
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Li B, Bi P, Ward A, Bell C, Fairley CK. Trends and predictors of recent HIV testing over 22 years among a clinic sample of men who have sex with men in South Australia. Sex Health 2019; 14:164-169. [PMID: 27832580 DOI: 10.1071/sh16091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/10/2016] [Indexed: 11/23/2022]
Abstract
Increasing the frequency of HIV testing is crucial for effective HIV prevention and care. The aim of the present study was to determine whether there has been a change in HIV testing among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) clinic over the past two decades. METHODS Computerised medical records of MSM who attended the SASSH at their first visit between 1994 and 2015 were used to determine whether HIV testing had changed among MSM. First HIV tests in each calendar year and return tests within 12 months were analysed. Factors associated with recent HIV testing were also examined. RESULTS There were 24036 HIV tests conducted among 8163 individual MSM over the study period. The proportion of newly registered MSM who reported ever being tested for HIV declined (Ptrend=0.030), the proportion who reported recent HIV testing did not change (Ptrend=0.955) and the proportion who have had current HIV testing increased (Ptrend=0.008). The proportion of MSM who returned to the clinic for HIV testing within 12 months did not change (Ptrend >0.05), with less than 40% of MSM returning for HIV testing. Factors independently associated with recent HIV testing included MSM aged ≥20 years, (odds ratio (OR) 1.79; 95% confidence interval (CI) 1.53-2.10), higher education (OR 1.28; 95% CI 1.12-1.45), non-Caucasian (African OR 1.68; 95% CI 1.30-2.17), having multiple sex partners (OR 1.47; 95% CI 1.29-1.69), having had sex interstate (OR 1.61; 95% CI 1.42-1.82) or overseas (OR 1.53; 95% CI 1.33-1.76) and injecting drug use (OR 1.56; 95% CI 1.29-1.88). CONCLUSIONS HIV testing rate among MSM attending SASSH was suboptimal. New approaches are needed to increase the uptake and early detection of HIV infection among the high-priority MSM population.
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Affiliation(s)
- Bin Li
- School of Public Health, The University of Adelaide, 178 North Terrace, Adelaide, SA 5000, Australia
| | - Peng Bi
- School of Public Health, The University of Adelaide, 178 North Terrace, Adelaide, SA 5000, Australia
| | - Alison Ward
- South Australia Specialist Sexual Health, Infectious Disease Unit, Royal Adelaide Hospital, 275 North Terrace, Adelaide, SA 5000, Australia
| | - Charlotte Bell
- South Australia Specialist Sexual Health, Infectious Disease Unit, Royal Adelaide Hospital, 275 North Terrace, Adelaide, SA 5000, Australia
| | - Christopher K Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 89 Commercial Road, Melbourne, Vic. 3004, Australia
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Holt M, Lea T, Bear B, Halliday D, Ellard J, Murphy D, Kolstee J, de Wit J. Trends in Attitudes to and the Use of HIV Pre-exposure Prophylaxis by Australian Gay and Bisexual Men, 2011-2017: Implications for Further Implementation from a Diffusion of Innovations Perspective. AIDS Behav 2019; 23:1939-1950. [PMID: 30539496 DOI: 10.1007/s10461-018-2368-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Using repeated, national, online, cross-sectional surveys of Australian gay and bisexual men (GBM), we analysed trends related to HIV pre-exposure prophylaxis (PrEP). Specifically, we analysed trends in PrEP use, willingness to use PrEP, and concern about using PrEP during 2011-2017. We assessed support for GBM using PrEP and willingness to have sex with men taking PrEP between 2015 and 2017. For time-based analyses, we used multivariate logistic regression, controlling for sampling variations over time. We constructed new scales assessing reduced concern about HIV among PrEP users and non-users in 2017, and used multivariate logistic regression to identify independent correlates of PrEP use (vs. non-use). The analyses included 4567 HIV-negative and untested participants (2011-2017). PrEP use increased from 0.5% in 2011 to 25.5% in 2017 (p < 0.001). Willingness to use PrEP increased from 27.9% in 2011 to 36.5% in 2017 (p < 0.001) while concern about using PrEP fell (52.1-36.1%, p < 0.001). Support for GBM using PrEP remained stable (52.5% in 2015, 51.9% in 2017, p = 0.62), and willingness to have sex with men taking PrEP increased from 34.9% in 2015 to 49.0% in 2017 (p < 0.001). In 2017, 22.8% of non-PrEP-users had reduced HIV concern because of PrEP, while 73.6% of PrEP users had reduced HIV concern and greater sexual pleasure because of PrEP. The analysis of PrEP users vs. non-users in 2017 indicated that PrEP users were more sexually active and reported higher risk sexual practices, were more likely to live in New South Wales and Victoria, and to be in full-time employment. They were also more likely to know HIV-positive people and other PrEP users. Diffusion of Innovations theory suggests that future PrEP users in Australia may be less adventurous and require greater reassurance about PrEP's efficacy and legitimacy, to sustain rollout and address current disparities in uptake.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
- Centre for Social Research in Health, UNSW Sydney, Level 2, John Goodsell Building, Sydney, NSW, 2052, Australia.
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Cologne, Germany
| | | | - Dale Halliday
- New South Wales Ministry of Health, Sydney, Australia
| | - Jeanne Ellard
- Australian Federation of AIDS Organisations, Sydney, Australia
| | - Dean Murphy
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Department of Gender and Cultural Studies, University of Sydney, Sydney, Australia
| | | | - John de Wit
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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Australia’s notifiable disease status, 2015: Annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In 2015, 67 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 320,480 notifications of communicable diseases to the National Notifiable Diseases Surveillance System, an increase of 16% on the number of notifications in 2014. In 2015, the most frequently notified diseases were vaccine preventable diseases (147,569 notifications, 46% of total notifications), sexually transmissible infections (95,468 notifications, 30% of total notifications), and gastrointestinal diseases (45,326 notifications, 14% of total notifications). There were 17,337 notifications of bloodborne diseases; 12,253 notifications of vectorborne diseases; 1,815 notifications of other bacterial infections; 710 notifications of zoonoses and 2 notifications of quarantinable diseases.
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Ryan KE, Wilkinson AL, Leitinger D, El-Hayek C, Ryan C, Pedrana A, Hellard M, Stoové M. Characteristics of gay, bisexual and other men who have sex with men testing and retesting at Australia's first shop-front rapid point-of-care HIV testing service. Sex Health 2018; 13:560-567. [PMID: 27509318 DOI: 10.1071/sh16027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/17/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND HIV rapid point-of-care (RPOC) testing was approved in Australia in 2012 prompting new testing models. We describe gay, bisexual and other men who have sex with men (GBM) testing in the first year of operations at Australia's first shop-front, community-based RPOC testing service, PRONTO!, and characterise return testers and first-time testers. METHODS Univariable and multivariable logistic regression using data collected at clients' first test at PRONTO! from 15 August 2013 to 14 August 2014 examined correlates of: 1) return-testing within 6 months of GBMs first test at PRONTO!; and 2) reporting a first ever HIV test at PRONTO!. RESULTS In the first year, 1226 GBM tested at PRONTO! (median age=30.4 years, 60.2% Australian born). Condomless anal sex with casual or regular partners was reported by 45% and 66% of GBM, respectively. Almost one-quarter (23%) of GBM returned within 6 months of their first test. Return-testing was associated with being born overseas (adjusted odds ratio (AOR)=1.48, 95% confidence interval (CI)=1.10-2.0), reporting a regular check-up as reason to test (AOR=1.53, 95% CI=1.01-2.30) and reporting a HIV test in the 6 months before first testing at PRONTO! (AOR=1.73, 95% CI=1.09-2.73). Reporting first testing at PRONTO! (17.9%) was positively associated with younger age (<30 years; AOR=1.78, 95% CI=1.18-2.71) and negatively associated with reporting a regular check-up as reason to test (AOR=0.45, 95% CI=0.29-0.71) and recent group sex (AOR=0.37, 95% CI=0.23-0.59). CONCLUSION Despite PRONTO! being designed to reduce barriers to HIV testing, return testing rates in the first year were low and not associated with client risk. Service refinements, including the provision of comprehensive sexually transmissible infection testing, are needed to increase testing frequency and enhance population HIV prevention benefits.
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Affiliation(s)
- Kathleen E Ryan
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Anna L Wilkinson
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - David Leitinger
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Carol El-Hayek
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Claire Ryan
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Alisa Pedrana
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Mark Stoové
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
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Ryan KE, Mak A, Stoove M, Price B, Fairley CK, Ruth S, Lal L, Asselin J, El-Hayek C, Nguyen L, Batrouney C, Wilson D, Lockwood J, Murphy D, Cornelisse VJ, Roth N, Willcox J, Chang CC, Armishaw J, Tee BK, Penn M, Forgan-Smith G, Williams C, Montgomery J, Byron K, Coelho A, Allen B, Wiggins J, Kelsall J, Vujovic O, West M, Pierce AB, Gallant D, Bell C, de Wit JBF, Hoy JF, Wesselingh SL, Grant RM, Wright EJ. Protocol for an HIV Pre-exposure Prophylaxis (PrEP) Population Level Intervention Study in Victoria Australia: The PrEPX Study. Front Public Health 2018; 6:151. [PMID: 29896468 PMCID: PMC5987055 DOI: 10.3389/fpubh.2018.00151] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Pre-exposure prophylaxis (PrEP) is the use of HIV anti-retroviral therapy to prevent HIV transmission in people at high risk of HIV acquisition. PrEP is highly efficacious when taken either daily, or in an on-demand schedule. In Australia co-formulated tenofovir-emtricitabine is registered for daily use for PrEP, however, this co-formulation is not listed yet on the national subsidized medicines list. We describe a study protocol that aims to demonstrate if the provision of PrEP to up to 3800 individuals at risk of HIV in Victoria, Australia reduces HIV incidence locally by 25% generally and 30% among GBM. Methods: PrEPX is a population level intervention study in Victoria, Australia in which generic PrEP will be delivered to 3800 individuals for up to 36 months. Study eligibility is consistent with the recently updated 2017 Australian PrEP guidelines. Participants will attend study clinics, shared care clinics, or outreach clinics for quarterly HIV/STI screening, biannual renal function tests and other clinical care as required. Study visits and STI diagnoses will be recorded electronically through the ACCESS surveillance system. At each study visit participants will be invited to complete behavioral surveys that collect demographics and sexual risk data. Diagnosis and behavioral data will be compared between PrEPX participants and other individuals testing within the ACCESS surveillance system. A subset of participants will complete in depth surveys and interviews to collect attitudes, beliefs and acceptability data. Participating clinics will provide clinic level data on implementation and management of PrEPX participants. The population level impact on HIV incidence will be assessed using Victorian HIV notification data. Discussion: This study will collect evidence on the real world impact of delivery of PrEP to 3800 individuals at risk of acquiring HIV in Victoria. This study will provide important information for the broader implementation of PrEP planning upon listing of the tenofovir-emtricitabine on the national subsidized list of medicines. The study is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12616001215415)
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Affiliation(s)
- Kathleen E Ryan
- The Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne Mak
- Alfred Health Pharmacy, Melbourne, VIC, Australia
| | - Mark Stoove
- The Burnet Institute, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Simon Ruth
- Victorian AIDS Council, Melbourne, VIC, Australia
| | - Luxshimi Lal
- The Burnet Institute, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
| | | | | | - Long Nguyen
- The Burnet Institute, Melbourne, VIC, Australia
| | | | | | | | - Dean Murphy
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Vincent J Cornelisse
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Norman Roth
- Prahran Market Clinic, Melbourne, VIC, Australia
| | | | - Christina C Chang
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | | | - Ban K Tee
- The Centre Clinic, Melbourne, VIC, Australia.,Access Health and Community Richmond, Melbourne, VIC, Australia
| | - Matthew Penn
- PRONTO! Community Health Centre, Melbourne, VIC, Australia
| | | | | | | | - Kat Byron
- Victorian Aboriginal Community Controlled Health Organisation Inc., Melbourne, VIC, Australia
| | - Alison Coelho
- Centre for Culture, Ethnicity and Health, Melbourne, VIC, Australia
| | - Brent Allen
- Living Positive Victoria, Melbourne, VIC, Australia
| | - Jeremy Wiggins
- Victorian AIDS Council, Melbourne, VIC, Australia.,Peer Advocacy Network for the Sexual Health of Trans Masculinities, Melbourne, VIC, Australia
| | | | - Olga Vujovic
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Michael West
- Sexual Health and Viral Hepatitis Service Department of Health and Human Services, Government of Victoria, Melbourne, VIC, Australia
| | - Anna B Pierce
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Daniel Gallant
- Sexually Transmissible Infection and Blood Borne Virus Section, Communicable Disease Control Branch, Department of Health and Ageing, Government of South Australia, Adelaide, SA, Australia
| | - Charlotte Bell
- Clinic 275, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John B F de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Robert M Grant
- School of Medicine, University of California San Francisco, Gladstone Institutes, San Francisco, CA, United States
| | - Edwina J Wright
- The Burnet Institute, Melbourne, VIC, Australia.,The Centre Clinic, Melbourne, VIC, Australia.,Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
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14
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Brown G, Prestage G, Down I, Ellard J, Triffitt K. Not so different? Comparison of risk profile of gay men who acquired HIV while travelling with those who acquired HIV in Australia. Health Promot J Austr 2017; 29:58-64. [PMID: 29700942 DOI: 10.1002/hpja.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 02/27/2017] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED Many countries now identify HIV and international mobility as a priority issue within a global and shared epidemic, including Australia. To support health promotion in this complex area, we investigated recent HIV infections that occurred among Australian gay men while travelling and compared to HIV infections that occurred in Australia. METHODS 446 gay men recently diagnosed with HIV completed an on-line survey regarding the high risk event (HRE) where they believed that they acquired HIV. Those who acquired HIV while in their usual place of residence (308 men), those who were travelling within Australia (59 men), and those who were travelling overseas (79 men) were compared. RESULTS Those who acquired HIV while overseas had very similar risk profiles, sexual behaviour, and made similar assumptions about their partners and their own HIV status, as those who acquired HIV in Australia. Only HIV status disclosure at the HRE differed across locations (P = .030). Three quarters (74.7%) of the men who acquired HIV while overseas were not diagnosed until they returned to Australia. CONCLUSIONS Our findings challenge the idea that there are necessarily differences in behaviour and assumptions for HIV transmission in Australia and overseas. However, the men travelling may be in communities where HIV status is less commonly disclosed, and where HIV prevalence is higher. SO WHAT?: A deeper understanding of contextual factors may be required for HIV prevention and health promotion strategies targeting gay men travelling to locations with different cultural, HIV prevalence, and HIV testing considerations. This would also identify opportunities for new tools such as Pre-Exposure Prophylaxis and self-testing.
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Affiliation(s)
- Graham Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Garrett Prestage
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Ian Down
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Jeanne Ellard
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Kathy Triffitt
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
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15
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Hammoud MA, Jin F, Lea T, Maher L, Grierson J, Prestage G. Off-Label Use of Phosphodiesterase Type 5 Inhibitor Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia: Results From the FLUX Study. J Sex Med 2017; 14:774-784. [PMID: 28583339 DOI: 10.1016/j.jsxm.2017.04.670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/16/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Gay and bisexual men (GBM) use oral erectile dysfunction medications (EDMs) often with little evidence of medical indication necessitating their use. AIM To investigate the prevalence, contexts, and motivations for oral EDM use and its relation to sexual risk behavior. METHODS A total of 2,250 Australian GBM completed an online survey of licit and illicit drug use and their associated behaviors. Multivariate logistic regression analysis identified factors associated with use of EDMs in the previous 6 months and, for those who had used EDMs, factors associated with use on a weekly basis. OUTCOMES Any EDM use and at least weekly use in the previous 6 months. RESULTS The median age of the sample was 33.0 years (range = 16-81). Two thirds (67.7%) reported no lifetime history of EDM use. Approximately 1 in 10 participants (11.1%) had last used an EDM more than 6 months previously. In the previous 6 months, 11.5% reported using EDMs less than monthly, 5.3% reported using EDMs approximately monthly, and 4.5% reported using EDMs at least weekly. Of men who had used EDMs in the previous 6 months, common reasons cited for its use were to maintain an erection for longer (73.3%), to make it easier to "get hard" (67.3%), and difficulty in attaining or maintain an erection (53.5%). Use of EDMs in the previous 6 months was associated with illicit drug use and higher rates of sexual risk behavior. Weekly users were more likely to have severe anxiety than less frequent users. CLINICAL TRANSLATION The use of EDMs in the context of intensive sex partying, with the associated potential for increased risk of HIV transmission and illicit drug use, indicates a need to consider the use of EDMs among GBM in HIV prevention and minimizing harm. STRENGTHS AND LIMITATIONS This large-scale study of drug use among GBMs includes comprehensive detailed data on their history of use and rationales for use. Our online methodology potentially decreases social desirability bias in reporting illegal or stigmatized behaviors. This volunteer online convenience sample might not be representative of all GBMs in Australia. CONCLUSION GBMs who used an oral EDM in the previous 6 months often used it for recreational purposes, but many of those who used it on a weekly basis also might have used it for therapeutic reasons. GBMs often use EDMs to enhance their sexual experiences often in the context of intensive sex partying (which can include risky sexual behavior). Hammoud MA, Jin F, Lea T, et al. Off-Label Use of Phosphodiesterase Type 5 Inhibitor Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia: Results From the FLUX Study. J Sex Med 2017;14:774-784.
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Affiliation(s)
- Mohamed A Hammoud
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Toby Lea
- Centre for Social Research in Health, University of New South Wales, Kensington, NSW, Australia
| | - Lisa Maher
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | | | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
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16
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Zhang L, Regan DG, Ong JJ, Gambhir M, Chow EP, Zou H, Law M, Hocking J, Fairley CK. Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective. Vaccine 2017; 35:4923-4929. [DOI: 10.1016/j.vaccine.2017.07.078] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 11/27/2022]
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17
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Philpot SP, Ellard J, Duncan D, Dowsett GW, Bavinton BR, Down I, Keen P, Hammoud MA, Prestage G. Gay and bisexual men's interest in marriage: an Australian perspective. CULTURE, HEALTH & SEXUALITY 2016; 18:1347-1362. [PMID: 27240739 DOI: 10.1080/13691058.2016.1184314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Same-sex marriage is a widely debated issue, including in Australia. This study used an online anonymous survey, with free-text responses, to investigate romantic and sexual relationships among Australian gay and bisexual men. We sought to identify what proportion of such men intended to marry their primary regular partner if marriage was made legally available to same-sex couples in Australia, as well as factors associated with intention or non-intention to marry. Most men in the sample did not intend to marry their primary regular partner. Even among men who considered themselves to be in a 'relationship' with their primary regular partner, less than half intended to marry him. However, many men who would not marry their current primary regular partner agreed that same-sex marriage should be available for gay and bisexual men in Australia. Reasons for intention to marry included a desire for social and legal equality, and ideas about marriage as a rite of passage, an expression of love and the most valued form of relationship in Australia. Those who did not intend to marry their primary regular partner offered a number of reasons, including that the nature of their relationship was incompatible with marriage, and reported a critical position towards marriage as a heteronormative institution.
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Affiliation(s)
| | - Jeanne Ellard
- a Kirby Institute, UNSW Australia , Sydney , Australia
- b Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
| | - Duane Duncan
- b Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
- c Behavioural, Cognitive and Social Sciences , University of New England , Armidale , Australia
| | - Gary W Dowsett
- b Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
- d Centre for Social Research in Health , UNSW Australia , Sydney , Australia
| | | | - Ian Down
- a Kirby Institute, UNSW Australia , Sydney , Australia
| | - Phillip Keen
- a Kirby Institute, UNSW Australia , Sydney , Australia
| | | | - Garrett Prestage
- a Kirby Institute, UNSW Australia , Sydney , Australia
- b Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia
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18
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Closson K, Lachowsky NJ, Cui Z, Shurgold S, Sereda P, Rich A, Moore DM, Roth EA, Hogg RS. Does age matter? Sexual event-level analysis of age-disparate sexual partners among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada. Sex Transm Infect 2016; 93:332-341. [PMID: 27852641 DOI: 10.1136/sextrans-2016-052721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/19/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To determine factors associated with age-disparate sexual partners among Vancouver gay, bisexual and other men who have sex with men (GBM). METHODS Sexually active GBM aged ≥16 years were recruited from February 2012 to February 2014. Participants self-completed a questionnaire on demographics, attitudes and sexual behaviour and substance use at last sexual event with five most recent partners. Two generalised linear mixed models identified factors associated with: (1) 'same-age' (referent), 'younger' or 'much-younger' and (2) 'same-age' (referent), 'older' or 'much-older' partners. Statistical interactions between age and HIV status were tested. RESULTS Participants (n=719) were predominantly gay (85.1%), White (75.0%), HIV-negative/unknown status (72.9%) with median age of 33 years (Q1,Q3: 26,47). A minority of sexual events were reported with much-older/much-younger partners (13.7%). In the multivariable models, GBM reporting older partners were more likely to be Asian or Latino, have greater Escape Motivation scores, report their partner used erectile dysfunction drugs (EDDs) and have received something for sex; compared with condom-protected insertive anal sex, participants with older partners were more likely to report condomless insertive anal sex with a serodiscordant or unknown status partner or no insertive anal sex. GBM reporting older partners were less likely to be bisexual-identified, have given something for sex and report event-level alcohol and EDD use. GBM reporting younger partners were more likely to have annual incomes >$30 000 and have met their partner online. As per significant statistical interactions, age-disparate relations were more common for younger HIV-positive and older HIV-negative GBM. CONCLUSIONS Differences among age-disparate partners highlight important targets for health promotion and future research.
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Affiliation(s)
- K Closson
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Science, Simon Fraser University, Burnaby, Canada
| | - N J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.,Centre for Addictions Research British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Z Cui
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - S Shurgold
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - P Sereda
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - A Rich
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - D M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - E A Roth
- Centre for Addictions Research British Columbia, University of Victoria, Victoria, British Columbia, Canada.,Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - R S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Science, Simon Fraser University, Burnaby, Canada
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19
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Skerrett DM, Kõlves K, De Leo D. Factors Related to Suicide in LGBT Populations. CRISIS 2016; 37:361-369. [DOI: 10.1027/0227-5910/a000423] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: There is evidence of heightened vulnerability to nonfatal suicidal behaviors among LGBT populations yet a paucity of studies into fatal behaviors. Aim: The specific aim of this article was to identify factors related to suicide in LGBT individuals in Australia. Method: The psychological autopsy (PA) method with a matched case-control study design was used. PA interviews were conducted with 27 next-of-kin of an LGBT person that had died by suicide. Three living LGBT controls per suicide case, matched by age and gender, were also interviewed. Results: The key factors relating to suicide in LGBT people were a lack of acceptance by family and self (reflected in higher internalized homophobia and shame), negative feelings about own sexuality/gender, and dissatisfaction with appearance. LGBT people who died by suicide also tended to go through coming out milestones 2 years earlier than controls. There was a higher prevalence of aggressive behaviors and a more predominant history of physical and sexual abuse. Additionally, there was greater incidence of depression and anxiety and alcohol and substance use disorders. Conclusion: Specific predictive factors for suicide in LGBT populations in Australia were identified, including significantly poorer mental health outcomes and more violence across an array of measures.
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Affiliation(s)
- Delaney Michael Skerrett
- Australian Institute for Suicide Research and Prevention (AISRAP), National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention (AISRAP), National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, QLD, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention (AISRAP), National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, QLD, Australia
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20
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Cheung KT, Fairley CK, Read TRH, Denham I, Fehler G, Bradshaw CS, Chen MY, Chow EPF. HIV Incidence and Predictors of Incident HIV among Men Who Have Sex with Men Attending a Sexual Health Clinic in Melbourne, Australia. PLoS One 2016; 11:e0156160. [PMID: 27219005 PMCID: PMC4878753 DOI: 10.1371/journal.pone.0156160] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 05/10/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the risk factors for HIV infection and the incidence in men who have sex with men (MSM). It is important to identify subgroups of MSM in which preventive interventions such as pre-exposure prophylaxis (PrEP) offered at the time of their last negative test would be considered cost-effective. METHODS We conducted a retrospective cohort study of MSM attending Melbourne Sexual Health Centre (MSHC) during 2007-2013 with at least two HIV tests within 12 months of each other. Demographic characteristics, sexual and other behaviours, and bacterial sexually transmitted infection (STI) diagnoses were extracted from the date of the last negative HIV test. HIV incidence rate (IR) per 100 person-years for each risk factor was calculated. RESULTS Of the 13907 MSM who attended MSHC, 5256 MSM had at least two HIV tests and were eligible, contributing 6391 person-years follow-up. 81 new HIV diagnoses were identified within 12 months of an HIV negative test with an incidence of 1.3 (95% CI: 1.0-1.6) per 100 person-years. Significant associations with subsequent HIV infection were: rectal gonorrhea (HIV IR: 3.4 95% CI: 2.1-5.2), rectal chlamydia (HIV IR: 2.6 95% CI: 1.7-3.7), inconsistent condom use (HIV IR: 2.1 95% CI: 1.6-2.7), use of post-exposure prophylaxis (HIV IR: 2.3 95% CI: 1.7-3.1), and injecting drug use (HIV IR: 8.5 95% CI: 3.4-17.5). CONCLUSION The incidence of HIV was above 2.0% in subgroups of MSM with specific characteristics at the last HIV negative test. PrEP is considered cost effective at this incidence and could potentially be used along with other preventive interventions for these individuals in more than half of the population.
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Affiliation(s)
- King T. Cheung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Tim R. H. Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Glenda Fehler
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Catriona S. Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Marcus Y. Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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21
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The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community-based, bio-behavioural survey. J Int AIDS Soc 2015; 18:20526. [PMID: 26563846 PMCID: PMC4643166 DOI: 10.7448/ias.18.1.20526] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/01/2015] [Accepted: 10/16/2015] [Indexed: 01/13/2023] Open
Abstract
Introduction Gay and bisexual men (GBM) with undiagnosed HIV are believed to contribute disproportionately to HIV transmission in Australia but national prevalence estimates have been lacking. Methods From November 2013 to November 2014, we recruited men at gay venues and events in six Australian states and territories. Of 7291 survey participants, 3071 men also provided an oral fluid sample for testing and decided whether to receive their test results or not. We calculated raw and population-weighted prevalence estimates and identified associations with undiagnosed infection using logistic regression. Results Of 3071 participants, 213 men tested HIV-positive (6.9%, 95% confidence interval [CI] 6.0 to 7.8%), of whom 19 (8.9%, 95% CI 5.8 to 13.5%) were previously undiagnosed. After weighting for the size of the gay and bisexual male population in each state or territory, national HIV prevalence was estimated to be 7.2% (95% CI 6.3 to 8.1), of which 9.1% (95% CI 6.0 to 13.6%) were estimated to be undiagnosed. Compared with HIV-negative participants, men with undiagnosed HIV were more likely to report meeting partners at sex venues, using antiretroviral drugs as pre-exposure prophylaxis, condomless anal intercourse with casual partners, using party drugs for sex, injecting drugs and using amyl nitrite, crystal methamphetamine or gamma hydroxybutyrate in the six months prior to the survey. Discussion The results indicate that the prevalence of undiagnosed HIV is relatively low among Australian GBM but is higher among men who report riskier sex and drug practices. Conclusions The results underline the importance of targeted HIV prevention and frequent testing for men at increased risk of infection.
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22
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Homosexual men in HIV serodiscordant relationships: implications for HIV treatment as prevention research. J Int AIDS Soc 2015; 18:19884. [PMID: 26015387 PMCID: PMC4733160 DOI: 10.7448/ias.18.1.19884] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/05/2015] [Accepted: 04/22/2015] [Indexed: 02/05/2023] Open
Abstract
Introduction Studies in heterosexual HIV serodiscordant couples have provided critical evidence on the role of HIV treatments in reducing HIV transmission risk. However, there are limited data regarding the effect of treatment on HIV transmission in homosexual male couples. We examined features of male homosexual HIV serodiscordant relationships that may impact upon the design of HIV treatment and transmission studies. Methods Data were from a prospective cohort study of HIV-negative homosexual men in Sydney, Australia. Men were followed up with six-monthly interviews and annual testing for HIV. Characteristics of men in HIV serodiscordant and seroconcordant relationships at baseline were compared, and a longitudinal analysis performed of rate of relationship break-up and of HIV incidence. Results At baseline, 5.5% of participants (n=79) had an HIV-positive partner. Most (80.8%) of these relationships were non-monogamous, and 36.7% of men reported recent unprotected anal intercourse (UAI) with casual partners. The rate of relationship break-up was 29.5 per 100 person-years. Half of men in serodiscordant relationships (49.4%) reported recent UAI with their regular partners. HIV incidence was 2.2 per 100 person-years. It was substantially higher in relationships of less than one year's duration (6.1 per 100 person-years) and in men who reported unprotected receptive anal intercourse with ejaculation with their regular partners (15.5 per 100 person-years). Conclusions Levels of HIV transmission risk and incidence were high, particularly in early relationships. Rates of relationship break-up were high. These data suggest that studies of HIV treatments and transmission in homosexual serodiscordant couples should focus on early relationships so as not to underestimate risk, and sample sizes must allow for high rates of relationship break-up.
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23
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Su JY, Holt J, Payne R, Gates K, Ewing A, Ryder N. Effectiveness of using Grindr to increase syphilis testing among men who have sex with men in Darwin, Australia. Aust N Z J Public Health 2015; 39:293-4. [PMID: 25716209 DOI: 10.1111/1753-6405.12342] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jiunn-Yih Su
- Centre for Disease Control, Northern Territory Department of Health
| | - Jan Holt
- Centre for Disease Control, Northern Territory Department of Health
| | - Rebecca Payne
- Centre for Disease Control, Northern Territory Department of Health
| | - Kim Gates
- Northern Territory AIDS and Hepatitis Council
| | | | - Nathan Ryder
- Centre for Disease Control, Northern Territory Department of Health
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Hopwood M, Lea T, Aggleton P. Multiple strategies are required to address the information and support needs of gay and bisexual men with hepatitis C in Australia. J Public Health (Oxf) 2015; 38:156-62. [PMID: 25626415 DOI: 10.1093/pubmed/fdv002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is increasingly reported among gay and bisexual men. However, little is known about the personal and social dimensions of HCV-related experience among these men in Australia. METHODS An online survey of 474 Australian gay and bisexual men was conducted from August to December 2013. A subsample of 48 HCV mono-infected and HIV/HCV co-infected men was analysed to explore HCV knowledge, sources of information, unmet information needs and use of HCV-related services. RESULTS More than half of respondents in the subsample were unaware that HIV infection increases the risk of sexually acquired HCV and most wanted information about how to prevent the sexual transmission of HCV. A majority of respondents requested gay-specific HCV services, and approximately similar proportions of men indicated that they would like these services delivered by a hepatitis organization, a lesbian, gay, bisexual, transgender and intersex (LGBTI) organization and a HIV organization. Men in receipt of HIV antiretroviral treatments were most likely to request that gay-specific HCV information and support services be delivered by a LGBTI or HIV organization (OR = 8.63). CONCLUSION These findings suggest that a variety of organizations are required to address the information and support needs of Australian gay and bisexual men with HCV.
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Affiliation(s)
- Max Hopwood
- Centre for Social Research in Health, University of New South Wales Australia, Sydney 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, University of New South Wales Australia, Sydney 2052, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, University of New South Wales Australia, Sydney 2052, Australia
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Lin AC, Fairley CK, Dutt K, Klassen KM, Chen MY, Fehler G, Law M, Bradshaw CS, Denham I, Read TRH, Chow EPF. Testing for HIV among men who have sex with men needs a paradigm shift in Australia, given the minimal increase between 2003 and 2013 in Melbourne, Australia. Sex Health 2015; 12:373-82. [PMID: 26188409 DOI: 10.1071/sh14167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 05/05/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Increasing the frequency of HIV testing in men who have sex with men (MSM) will reduce the incidence of HIV. Trends in HIV testing among MSM in Melbourne, Australia over the last 11 years have been investigated. METHODS A retrospective study was conducted using electronic medical records of the first presentation of MSM who attended the Melbourne Sexual Health Centre between 2003 and 2013. Factors associated with HIV testing (year, demographic characteristics and sexual practices) were examined in multivariable logistic regression analyses. Jonckheere-Terpstra tests were used to examine the significance of trends in the mean time since the last HIV test. RESULTS Of 17578 MSM seen; 13489 attended for the first time during the study period. The proportion of first attendances who had previously tested and reported a HIV test in the last 12 months increased from 43.6% in 2003 to 56.9% in 2013 (adjusted ptrend=0.030), with a corresponding decrease in median time since the last HIV test from 19 months [interquartile range (IQR) 6-42] in 2003 to 10 months (IQR4-24) in 2013 (ptrend <0.001). The proportion of high-risk MSM (who reported unprotected anal intercourse and/or >20 partners in 12 months) who reported an HIV test in the last 12 months was unchanged (ptrend = 0.242). CONCLUSIONS Despite HIV testing becoming more frequent, the magnitude of change over the last decade is insufficient to substantially reduce HIV incidence. A paradigm shift is required to remove barriers to testing through strategies such as point-of-care rapid testing or access to testing without seeing a clinician.
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Affiliation(s)
- An-Chieh Lin
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Krishneel Dutt
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Karen M Klassen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Glenda Fehler
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Tim R H Read
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
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Skerrett DM, Kõlves K, De Leo D. Suicides among lesbian, gay, bisexual, and transgender populations in Australia: an analysis of the Queensland Suicide Register. Asia Pac Psychiatry 2014; 6:440-6. [PMID: 24692051 DOI: 10.1111/appy.12128] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 02/06/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sexual orientation is seldom recorded at death in Australia, and to date there have been no studies on the relationship between those that have died by suicide and sexuality or minority gender identity in Australia. The aim of the present study is to determine whether or not lesbian, gay, bisexual, transgender (LGBT), and intersex individuals who die by suicide constitute a unique subpopulation of those who die by suicide, when compared with non-lesbian, gay, bisexual, transgender, and intersex suicide deaths. METHODS The Queensland Suicide Register holds records of all suicides in Queensland since 1990. All cases from 2000 to 2009 (inclusive; a total of 5,966 cases) were checked for potential indicators of individuals' sexual orientation and gender identification. A total of 35 lesbian (n = 10), gay (n = 22), bisexual (n = 2), and transgender (n = 1) suicide cases were identified. Three comparison cases of non-LGBT suicides for each LGBT suicide were then located, matched by age and gender. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals. RESULTS It was significantly more likely that depression was mentioned in the cases of LGBT suicides than in non-LGBT cases. While 12.4% of the comparison group had been diagnosed with psychotic disorders, there were no such diagnoses among LGBT individuals. LGBT individuals experienced relationship problems more often, with relationship conflict also being more frequent than in non-LGBT cases. DISCUSSION Despite its limitations, this study - the first of its kind in Australia - seems to indicate that LGBT people would require targeted approaches in mental and general health services.
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Affiliation(s)
- Delaney Michael Skerrett
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Mt Gravatt, Queensland, Australia
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Prevalence and correlates of sexual partner concurrency among Australian gay men aged 18-39 years. AIDS Behav 2014; 18:801-9. [PMID: 24057932 DOI: 10.1007/s10461-013-0613-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mathematical models predict higher rates of HIV and sexually transmitted infections (STIs) in populations with higher rates of concurrent sexual partnerships. Although gay men and other men who have sex with men (MSM) have disproportionately high rates of HIV/STIs, little is known about the prevalence and correlates of sexual concurrency in these populations. This paper reports findings from a national community-based survey of 1,034 Australian gay-identified men aged 18-39 years, who gave detailed information about their sexual partners over the past 12 months. In all, 237 (23 %) reported two or more concurrent sexual partners. For their most recent period of concurrency, 44 % reported three or more partners and 66 % reported unprotected sex with one or more of their partners. A multivariate logistic regression found sexual concurrency was significantly more likely among men on higher incomes (P = 0.02), who first had anal sex at a relatively young age (P = 0.03), and who reported a large number of partners in the past 12 months (P < 0.001). Age, education, HIV status, and other sociodemographic and sexual behavior variables were not significant correlates. However, men who reported sexual concurrency were significantly more likely to have been diagnosed with an STI in the past 12 months (P = 0.04). Findings from this study suggest sexual concurrency is common among younger Australian gay men. With many of these men not always using condoms, health agencies should consider the potential impact of concurrency on HIV/STI epidemics among gay men and other MSM.
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Prestage G, Jin F, Bavinton B, Grulich A, Brown G, Pitts M, Hurley M. Australian Gay and Bisexual Men's Use of Erectile Dysfunction Medications During Recent Sexual Encounters. J Sex Med 2014; 11:809-19. [DOI: 10.1111/jsm.12407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Schneider K, Gray RT, Wilson DP. A cost-effectiveness analysis of HIV preexposure prophylaxis for men who have sex with men in Australia. Clin Infect Dis 2014; 58:1027-34. [PMID: 24385445 DOI: 10.1093/cid/cit946] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) used as preexposure prophylaxis (PrEP) by human immunodeficiency virus (HIV)-seronegative individuals reduces the risk of acquiring HIV. However, the population-level impact and cost-effectiveness of using PrEP as a public health intervention remains debated. METHODS We used a stochastic agent-based model of HIV transmission and progression to simulate the clinical and cost outcomes of different strategies of providing PrEP to men who have sex with men (MSM) in New South Wales (NSW), Australia. Model outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2013 Australian dollars per quality-adjusted life-year gained (QALYG). RESULTS The use of PrEP in 10%-30% of the entire NSW MSM population was projected to cost an additional $316-$952 million over the course of 10 years, and cost >$400 000 per QALYG compared with the status quo. Targeting MSM with sexual partners ranging between >10 to >50 partners within 6 months cost an additional $31-$331 million dollars, and cost >$110 000 per QALYG compared with the status quo. We found that preexposure prophylaxis is most cost-effective when targeted for HIV-negative MSM in a discordant regular partnership. The ICERs ranged between $8399 and $11 575, for coverage ranging between 15% and 30%, respectively. CONCLUSIONS Targeting HIV-negative MSM in a discordant regular partnership is a cost-effective intervention. However, this highly targeted strategy would not have large population-level impact. Other scenarios are unlikely to be cost-effective.
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Affiliation(s)
- Karen Schneider
- The Kirby Institute for Infection and Immunity in Society, The University of New South Wales, Sydney, Australia
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Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends. AIDS Behav 2013; 17:3133-44. [PMID: 23605157 DOI: 10.1007/s10461-013-0485-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Repeated behavioural surveillance should sample all epidemiologically relevant subgroups to provide a complete picture of trends in HIV risk behaviours. Web-based recruitment has been mooted but little empirical data exist on country experiences. We describe who is omitted from three rounds of a conventional offline-only surveillance programme among men who have sex with men (MSM) 2006-2011, but recruited subsequently on Internet dating sites, and the implications of this for understanding trends. The latter were younger, less gay identified and less gay community attached. Importantly, they reported different partnering patterns, lower condom use with casual and fuckbuddy-type male partners, and lower rates of HIV testing, compared to MSM routinely captured in offline surveillance. The replacement of offline socio-sexual activity by the Internet among many MSM means that current venue-based surveillance systems may underestimate risk behaviours, overlook trends among unsampled online MSM, and misinterpret trends observed in sampled MSM due to "sample drift" of most-at-risk MSM.
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Bavinton BR, Gray J, Prestage G. Assessing the effectiveness of HIV prevention peer education workshops for gay men in community settings. Aust N Z J Public Health 2013; 37:305-10. [DOI: 10.1111/1753-6405.12076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Thomas C, Wootten A, Robinson P. The experiences of gay and bisexual men diagnosed with prostate cancer: results from an online focus group. Eur J Cancer Care (Engl) 2013; 22:522-9. [PMID: 23730947 DOI: 10.1111/ecc.12058] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2013] [Indexed: 11/26/2022]
Abstract
Research concerning gay and bisexual men diagnosed with prostate cancer is sparse. An online focus group was conducted over a 4-week period with participants responding to a range of discussion questions concerning their experiences following a prostate cancer diagnosis. Emerging themes were identified and consensus reached. A summary of each of the themes was produced which the coders agreed conveyed the essence of the online discussion. All men who took part in the online focus group reported that prostate cancer significantly impacted their lives. Unexpectedly, some participants actually gained a positive perspective and adopted a sense of empowerment. Participants spoke about emotional responses to a diagnosis of prostate cancer, accessing help and support, the impact of incontinence, the impact of sexual changes on identity, a re-evaluation of life, changed sexual relationships, the need to find the most suitable healthcare professionals and identification of current needs to improve quality of care. These areas of disquiet suggest that the psychological impact of this disease may be quite significant over an extended time-frame. Further research needs to be undertaken to assess the degree of distress accompanying the treatment of gay and bisexual men with prostate cancer.
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Affiliation(s)
- C Thomas
- School of Human Biosciences and Public Health, La Trobe University, Melbourne, Victoria, Australia.
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Abstract
BACKGROUND Chlamydia trachomatis is a common bacterial sexually transmitted infection in men who have sex with men (MSM), although little is known about its distribution in Australian MSM communities. METHODS From 2004 to 2008, 612 consecutive C. trachomatis positive anal swab and urine samples were collected for genotyping and quantification from MSM attending 2 sexual health centers (Melbourne and Sydney). RESULTS The most common serovars detected were D (35.2%), G (32.7%), and J (17.7%), although these distributions changed significantly by year and city. C. trachomatis infections (2.8%) involved more than 1 serovar and only 1 lymphogranuloma venereum isolate was detected. The majority of serovar strains showed an identical omp1 genotype, with only 7.5% showing genotypic variability. Serovar G infections were not associated with overseas sexual activity; whilst individuals with serovar J were less likely to have had a prior C. trachomatis infection, and with serovar E were those who had prior C. trachomatis infection. Symptoms were present in 68% of urethral infections and 28% anal infections, and were associated with gonorrheal coinfection (13.8%), prior C. trachomatis infection (20.6%) and increasing age. A higher C. trachomatis load was identified in anal samples versus urine (1.48 × 10(4) genome copies/anal swab; 3.72 × 10(3) copies/mL urine) and no association was made to concentration including the presence of symptoms and prior C. trachomatis infection. CONCLUSIONS This is the largest study of C. trachomatis serovars in MSM: it is the first to report C. trachomatis rectal loads, and provides an overview on C. trachomatis serovars and genotypic variants that circulate in Australian MSM communities.
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Chlamydia trends in men who have sex with men attending sexual health services in Australia, 2004-2008. Sex Transm Dis 2013; 38:339-46. [PMID: 21217421 DOI: 10.1097/olq.0b013e318202719d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In most Australian settings, chlamydia notifications do not contain information on the gender of sexual partners. We assessed trends and predictors of chlamydia testing and positivity among men who have sex with men (MSM), attending sexual health services in Australia. METHODS The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) program was established in 2008 to collate demographic and chlamydia testing information from 25 sexual health services. We calculated the proportion tested and chlamydia positivity among MSM and assessed trends from 2004 to 2008 using a χ2 test and predictors using logistic regression. RESULTS In the 5-year period, 11,777 MSM attended as new patients (first visit ever to the service) and the proportion tested for chlamydia increased significantly from 71% in 2004 to 79% in 2008 (P < 0.01). Independent predictors of chlamydia testing were younger age, residing in a metropolitan area (adjusted prevalence ratio [APR] = 1.23; 95% confidence interval [CI]: 1.19, 1.27), being Australian-born (APR = 1.03; 95% CI: 1.01, 1.06), being a traveler or migrant (APR = 1.09; 95% CI: 1.06, 1.12), and sex overseas in the past year (APR = 1.05; 95% CI: 1.03, 1.07). Overall chlamydia positivity was 8.6% (95% CI: 8.0%-9.2%). There was no significant trend in chlamydia positivity between 2004 and 2008. Independent predictors of chlamydia positivity were younger age, being a traveler or migrant (APR = 1.52; 95% CI: 1.26-1.84), and exclusive same-sex contact (APR = 1.28; 95% CI: 1.05-1.55). CONCLUSIONS This new national surveillance program demonstrates that the majority of MSM attending sexual health services was offered chlamydia testing and testing has increased over time. The MSM at highest risk of chlamydia were more likely to be tested. Chlamydia transmission was frequent but stable among MSM accessing clinical services.
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Mao L, Adam P, Kippax S, Holt M, Prestage G, Calmette Y, Zablotska I, de Wit J. HIV-negative gay men's perceived HIV risk hierarchy: imaginary or real? AIDS Behav 2013; 17:1362-9. [PMID: 23314802 DOI: 10.1007/s10461-012-0406-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV-related risk perceptions and risk practices among gay men have changed over time. We revisited perceived HIV risk and engagement in anal intercourse with casual partners among HIV-negative gay men who participated in one of the Sydney Gay Community Periodic Surveys (GCPS). Perceived HIV risk was assessed by a range of anal intercourse practices combined with pre-specified casual partners' HIV status and viral load levels. Perceived HIV risk forms a potential hierarchy, broadly reflecting differences in the probability of HIV transmission through various anal intercourse practices. To a lesser extent, it also varies by casual partners' HIV status and viral load. Men who had unprotected anal intercourse with casual partners (UAIC) perceived lower HIV risk than those who used condoms consistently in the 6 months prior to survey. Recognising the complex associations between risk perceptions and risk practices helps to better address challenges arising from the 'Treatment as Prevention' (TasP).
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Gray RT, Prestage GP, Down I, Ghaus MH, Hoare A, Bradley J, Wilson DP. Increased HIV testing will modestly reduce HIV incidence among gay men in NSW and would be acceptable if HIV testing becomes convenient. PLoS One 2013; 8:e55449. [PMID: 23457470 PMCID: PMC3574096 DOI: 10.1371/journal.pone.0055449] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 12/29/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Determine the acceptability and epidemiological impact of increases in HIV testing in gay men in New South Wales (NSW), Australia- particularly pertinent when considering treatment as prevention and the need to reduce undiagnosed infections. METHODS We conducted an online survey and focus groups to assess whether increases in HIV testing would be acceptable to gay men in NSW. In parallel, we assessed the potential impact of increases in testing coverage and/or frequency using an individual-based model of HIV transmission. RESULTS If sexual practices and the rate of initiating HIV treatment are unchanged then increasing HIV testing reduces infections. Increasing testing frequency has the largest impact, with a 13.8% reduction in HIV infections over 10 years if the ∼55-75% of men who test at least once per year increased their testing frequency to four times per year. If testing levels decrease from current levels then we expect an increase in HIV infections with a sharply rising trend over time. Increasing HIV testing would be acceptable if testing was more convenient. However, only ∼25% of men surveyed were 'very likely' to increase their level of HIV testing. Men delayed or avoided testing due to the slowness in obtaining results and if they believed they had not put themselves at risk. CONCLUSIONS An increase in HIV testing alone is unlikely to reduce HIV incidence substantially in NSW gay men- however, the relatively high testing levels need to continue to prevent an increase in HIV infections. In jurisdictions with lower levels of HIV testing, increases in testing coverage and frequency are likely to have a larger impact. Successful treatment as prevention interventions will require increases in testing rates; such increases would be acceptable to gay men in NSW but only if more convenient testing and rapid communication of results were available.
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Affiliation(s)
- Richard T Gray
- The Kirby Institute, University of New South Wales, Sydney, Australia.
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Zablotska I, Wit JD, Brown G, Maycock B, Fairley C, McKechnie M, Prestage G. Protocol for a Respondent-Driven Sampling Study Exploring the Roles of Peer Norms in HIV-Related Practices of Gay Men. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wja.2013.34041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ali H, Donovan B, Fairley CK, Ryder N, McNulty A, Chen MY, Marshall L, O'Connor CC, Dickson B, Grulich AE, Hellard ME, Kaldor JM, Guy RJ. Are Australian sexual health clinics attracting priority populations? Sex Health 2013; 10:456-9. [DOI: 10.1071/sh13066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/27/2013] [Indexed: 11/23/2022]
Abstract
To answer a key question (‘Are Australian sexual health clinics attracting priority populations?’), we used data from 44 Australian sexual health clinics between 2004 and 2011. We assessed the proportion of patients that were from priority populations (deemed to be at risk of sexually transmissible infections) and compared this to their proportions in the general population using data from Australian Bureau of Statistics and the Australian Study of Health and Relationships. A χ2-test was used. A total of 278 154 new patients attended during 2004–2011. The proportions from each priority population were significantly higher (P < 0.01 for all) than for the general population: young people aged 15–29 years (58.1% v. 20.1%), men who have sex with men (26.0% v. 6.0%), female sex workers (10.8% v. 0.5%), and Aboriginal and Torres Strait Islander people (4.2% v. 2.3%). This study confirms that Australian sexual health clinics attract higher proportions of priority populations and are thus meeting their mandate as defined in the 2010–2013 National Sexually Transmissible Infections Strategy.
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Thériault N, Bi P, Hiller JE, Nor M. Use of web 2.0 to recruit Australian gay men to an online HIV/AIDS survey. J Med Internet Res 2012; 14:e149. [PMID: 23128646 PMCID: PMC3510723 DOI: 10.2196/jmir.1819] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 02/01/2012] [Accepted: 04/07/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Continuous prevention efforts for human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are recommended among those men who have sex with men (MSM). Creative use of e-technologies coupled with a better understanding of social networks could lead to improved health interventions among this risk population. OBJECTIVE The aims of the study were to (1) compare the impact of various advertising strategies on recruiting MSM participants to an online HIV/AIDS survey, and (2) explore the feasibility of using a social network service (SNS) for study advertising. METHODS A cross-sectional online survey was conducted in 2009. South Australian men over 18 years were invited to participate if they had had sexual intercourse with men in the previous year. A short questionnaire was used to collect demographics and information on sexual behavior, HIV history, use of the Internet for dating purposes, and sources of health information. The survey was promoted in community settings and online, including advertisements through social networks. RESULTS A total of 243 men completed the online survey during the 8-week data collection period. Online advertisements recruited 91.7% (220/240) of the sample. Conversely, traditional advertisements in the community recruited only 5.8% (14/240) of the sample. Ten volunteers were asked to advertise on their personal SNS application, but only 2 effectively did so. Only 18/240 (7.5%) of the respondents reported having learned of our study through the SNS application. In this sample, 19.3% (47/243) of participants had never been tested for HIV. Among the participants who had been tested, 12.8% (25/196) reported being HIV-positive. Regarding Internet use, 82.3% (200/243) of participants had dated online in the previous 6 months. Among the participants who had dated online, most (175/200, 87.5%) had found an Internet sexual partner and two-thirds (132/200, 66.0%) had had anal sex with these partner(s). Among men who had anal sex with an Internet partner, 68.2% (90/132) used a condom during sex. CONCLUSIONS The MSM participants in this study had high-risk profiles for HIV and other sexually transmitted diseases (STDs), which highlights the need for ongoing health interventions among this group. In this study, the SNS marketing strategy did not appear to create a viral effect and it had a relatively poor yield.
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Affiliation(s)
- Nathanaelle Thériault
- Direction régionale de santé publique de la Capitale-Nationale, Agence de la santé et des services sociaux de la Capitale-Nationale, Quebec, QC, Canada
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Lyons A, Pitts M, Grierson J. Exploring the psychological impact of HIV: health comparisons of older Australian HIV-positive and HIV-negative gay men. AIDS Behav 2012; 16:2340-9. [PMID: 22790849 DOI: 10.1007/s10461-012-0252-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Little is known about the impact of HIV on the mental health of older gay men. In a nationwide online survey, 1,135 Australian gay men aged 40 years and older reported on their physical and mental health. Compared with HIV-negative men, those with HIV were more likely to report currently receiving treatment for a mental health condition (37 vs. 25 %, p = 0.001), but no more likely to report treatment for a major physical health condition other than HIV (39 % vs. 40 %). On a measure of psychological distress, more HIV-positive men were highly distressed (14 vs. 8 %, p = 0.01). There were no significant differences in mental health across age groups for either HIV-positive or HIV-negative men. Underlying factors for poorer mental health included lower income (p = 0.003), not working (p = 0.004), living alone (p = 0.03), treatment for a major physical health condition (p < 0.001), recent experiences of discrimination (p = 0.03), and regarding one's sexual orientation as an essential part of self-identity (p < 0.001). With disparities between older HIV-positive and HIV-negative gay men greater for mental than physical health, more attention may need to be given to the psychological well-being of those living with HIV, particularly by addressing underlying psychosocial factors.
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Heymer KJ, Wentzlaff-Eggebert M, Mortimer E, Wilson DP. An economic case for providing free access to antiretroviral therapy for HIV-positive people in South Australia. Sex Health 2012; 9:220-6. [PMID: 22697138 DOI: 10.1071/sh10148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 07/11/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND As financial constraints can be a barrier to accessing HIV antiretroviral therapy (ART), we argue for the removal of copayment requirements from HIV medications in South Australia. METHODS Using a simple mathematical model informed by available behavioural and biological data and reflecting the HIV epidemiology in South Australia, we calculated the expected number of new HIV transmissions caused by persons who are not currently on ART compared with transmissions for people on ART. The extra financial investment required to cover the copayments to prevent an HIV infection was compared with the treatment costs saved due to averting HIV infections. RESULTS It was estimated that one HIV infection is prevented per year for every 31.4 persons (median, 24.0-42.7 interquartile range (IQR)) who receive treatment. By considering the incremental change in costs and outcomes of a change in program from the current status quo, it would cost the health sector $17860 per infection averted (median, $13651-24287 IQR) if ART is provided as a three-dose, three-drug combination without requirements for user-pay copayments. CONCLUSIONS The costs of removing copayment fees for ART are less than the costs of treating extra HIV infections that would result under current conditions. Removing the copayment requirement for HIV medication would be cost-effective from a governmental perspective.
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Affiliation(s)
- Kelly-Jean Heymer
- Faculty of Medicine, The University of New South Wales, Sydney, NSW 2010, Australia
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Lyons A, Pitts M, Grierson J, Smith A, McNally S, Couch M. Sexual behavior and HIV testing among bisexual men: a nationwide comparison of Australian bisexual-identifying and gay-identifying men. AIDS Behav 2012; 16:1934-43. [PMID: 22290610 DOI: 10.1007/s10461-012-0148-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Men who have sex with men (MSM) are typically studied as though they were a homogeneous population. This has resulted in a lack of knowledge about the sexual health and behavior of bisexual men as distinct from gay men. In this study, patterns of sexual behavior and rates of HIV testing were compared between 854 gay-identifying and 164 bisexual-identifying men who participated in an Australian nationwide online survey. Approximately half of both groups engaged in unprotected anal intercourse (UAI) at their most recent sexual encounter, but bisexual-identifying men were more likely to have had sex with a partner who was either serodiscordant or with whom their seroconcordance was unknown. Despite these patterns, only 62% of bisexual-identifying men had ever been tested for HIV compared to 84% of gay-identifying men. Multivariate logistic regression focused on rates of UAI and HIV testing among bisexual-identifying men. Patterns were similar across all age groups and educational backgrounds. However, bisexual-identifying men were less likely to engage in UAI with a casual partner and were more likely to have been tested for HIV if they had multiple partners or had disclosed their sexual orientation to their social networks. In all, these data reveal important differences between gay- and bisexual-identifying men, particularly with regard to HIV testing, and highlight a need for HIV prevention strategies to focus more strategically on finding ways of promoting safer sex and HIV testing among all MSM.
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Affiliation(s)
- Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia,
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Pedrana AE, Hellard ME, Guy R, Wilson K, Stoove M. The difference in self-reported and biological measured HIV prevalence: implications for HIV prevention. AIDS Behav 2012; 16:1454-63. [PMID: 22205325 DOI: 10.1007/s10461-011-0116-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Australia, HIV prevalence estimates among gay men have been mainly based on self-reported HIV status collected in annual behavioural surveys. We measured biological HIV prevalence among gay men in Melbourne, Australia, using a facility based sampling method. We calculated HIV prevalence and used logistic regression to assess correlates of a positive HIV test. A total of 639 gay men were recruited completed a survey and provided oral fluid for HIV testing from seven venues in 2008. The median age of the participants was 35 years (range 18-75 years). Overall biological HIV prevalence was 9.5% (95% CI 7.5-12.0%) compared with 6.3% (95% CI 4.5-8.4%) for self-reported HIV positive status. We found a significant discrepancy between test detected biological and self-report HIV status in our study, with 19 men (31.1%) unaware of their HIV infection. These results highlight the importance of repeatable biological estimates to inform and evaluate HIV prevention strategies.
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Affiliation(s)
- Alisa E Pedrana
- Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia.
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Holt M, Lee E, Prestage GP, Zablotska I, de Wit J, Mao L. The converging and diverging characteristics of HIV-positive and HIV-negative gay men in the Australian Gay Community Periodic Surveys, 2000-2009. AIDS Care 2012; 25:28-37. [PMID: 22639958 DOI: 10.1080/09540121.2012.686598] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To assess the changing health promotion needs of human immunodeficiency virus (HIV)-positive gay men in Australia, we analysed the social and behavioural characteristics of HIV-positive men in the Australian Gay Community Periodic Surveys. We looked at change over time in the characteristics of HIV-positive men (from 2000-2001 to 2008-2009) and compared HIV-positive men with their HIV-negative peers within each time period. Multivariate logistic regression analysis was used to assess independent changes over time within each HIV status group. A total of 21,620 responses were included in the analyses; 10,537 in 2000-2001 and 11,083 in 2008-2009. Between the two time periods, HIV-positive and HIV-negative men became more similar in the following areas: paid employment, sexual identity, number of male sex partners, the likelihood of having a regular male partner and having a seroconcordant regular male partner. The two groups diverged in these areas: age, ethnicity, educational level, social engagement with gay men, types of relationship with regular male partners, likelihood of unprotected anal intercourse with casual male partners and likelihood of HIV disclosure to casual male partners. Workforce participation and educational attainment have improved among HIV-positive gay men since 2000, but they still lag behind their HIV-negative peers in these areas. Because HIV-positive men are an ageing cohort, support services will need to increasingly address issues of HIV, sexuality and ageing with HIV-positive men. The increase in unprotected anal intercourse and HIV disclosure with casual partners means that education and support services will increasingly need to address effective HIV disclosure and non-condom-based risk reduction strategies with both HIV-positive and HIV-negative gay men.
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Affiliation(s)
- Martin Holt
- National Centre in HIV Social Research, The University of New South Wales, Sydney, Australia.
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Saxton PJW, Dickson NP, McAllister SM, Hughes AJ, Sharples K. HIV prevalence among men who have sex with men in New Zealand 1985–2009: 25 years of public health monitoring. Int J STD AIDS 2012; 23:274-9. [DOI: 10.1258/ijsa.2011.011213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Annual population-based estimates of the number of men who have sex with men (MSM) with diagnosed HIV infection (HIV prevalence pool), and the proportion of all MSM this represents (HIV prevalence), have been insufficiently described over the long term. We investigated the dynamic effects of ongoing HIV diagnoses, lower mortality due to treatment and growth in the MSM population over time on these two epidemic indicators using national HIV/AIDS surveillance data in New Zealand, 1985–2009. The diagnosed HIV prevalence pool rose 79% between 1989 and 1999, and 137% between 1999 and 2009. Estimates of diagnosed HIV prevalence as a proportion of MSM were 0.2% of MSM in 1985, and were between 1.5% and 5.0% of MSM by 2009. New Zealand continues to have a relatively low-prevalence HIV epidemic among MSM; however, the number of MSM living with diagnosed infection is growing rapidly 25 years after HIV testing was introduced.
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Affiliation(s)
- P J W Saxton
- AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 913, Dunedin
- Research Unit, New Zealand AIDS Foundation, Auckland, New Zealand
| | - N P Dickson
- AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 913, Dunedin
| | - S M McAllister
- AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 913, Dunedin
| | - A J Hughes
- Research Unit, New Zealand AIDS Foundation, Auckland, New Zealand
| | - K Sharples
- AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 913, Dunedin
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Abstract
BACKGROUND Reducing rates of partner change and increasing condom usage among gay men are obvious targets for potentially reducing syphilis transmission among gay men. METHODS We developed an agent-based stochastic model to examine syphilis transmission among a population of gay men, representative of gay men in Australia. This model was used to explore the potential impact of changes in sexual behavior over 1 month, 3 month, and indefinite time frames on syphilis epidemics. RESULTS Simulations of interventions showed that short-term reductions in rates of partner change and increased condom use would have negligible impact on the long-term trends of syphilis epidemics. If no interventions are introduced, then the model forecasts that the syphilis prevalence in the population could continue to rise, with an increase of 80% in the number of men infected with syphilis during the next decade. However, if changes in sexual behavior are maintained in the long-term, then syphilis epidemics can be mitigated. If condom use is sustained at 80% in partnerships that are HIV discordant or of unknown status, then the prevalence of syphilis is estimated to decrease by 9% over 10 years. Similarly, if partner acquisition rates decrease by 25%, then there will be a 22% reduction in syphilis prevalence. CONCLUSIONS Interventions promoting partner reduction or increased condom use would be ineffective in the short-term, and would have limited prospects for success in the long-term unless very large changes in behavior are sustained. Complementary social research indicates that such long-term changes in behavior are unlikely to be adopted, and therefore other intervention strategies need to be developed to reduce syphilis among gay men.
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High rates of undiagnosed HIV infections in a community sample of gay men in Melbourne, Australia. J Acquir Immune Defic Syndr 2012; 59:94-9. [PMID: 21992925 DOI: 10.1097/qai.0b013e3182396869] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Undiagnosed HIV infections contribute disproportionately to the HIV epidemic. We recruited 639 gay men attending social venues, who completed a cross-sectional survey with oral fluid collection for HIV testing in 2008. We calculated HIV and undiagnosed HIV prevalence and used χ(2) tests and logistic regression to examine associations between participant characteristics and HIV status. Among 639 men, 61 (9.5%, 95% confidence interval: 7.4% to 12.1%) tested HIV positive, of which 19 (31.1%, 95%confidence interval: 19.9% to 44.3%) were classified as undiagnosed HIV positive. Almost a third of HIV-positive men were unaware of their HIV status, and of these men, a large proportion engaged in high-risk behaviors.
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Poynten IM, Stein AN, Conway EL, Prestage G, Regan DG, Jin F, Hocking J, Grulich AE. Geographical clustering of anal cancer incidence in Australia. Sex Health 2012; 9:509-12. [DOI: 10.1071/sh12039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 04/19/2012] [Indexed: 11/23/2022]
Abstract
Introduction: Homosexual men are at an increased risk of anal cancer. We aimed to establish the burden of anal squamous cell carcinoma (SCC) in those parts of Australia where homosexual men are most likely to live. Methods: Data on the proportion of homosexual male residents were obtained from published estimates. Men were categorised into three postcode groups by prevalence of men reporting homosexual identity. Male population data in age groups were extracted for each postcode group and analyses of cancer incidence were performed by postcode group. The analyses were restricted to 2000–2005. Results: Eight postcodes had populations where more than 10% of males reported homosexual identity (high prevalence) and 4–10% of men reported homosexual activity in a further 19 postcodes (medium prevalence). From 2000 to 2005, the average annual age-standardised incidence rates of anal SCC in males was 7.61 per 100 000 (95% confidence interval (CI): 4.68–10.55) and 2.21 per 100 000 (95% CI: 1.05–3.37) in high and medium prevalence postcodes, respectively. The corresponding incidence rate ratios compared with low prevalence postcodes (less than 4% of males reported homosexual identity) were 9.6 (95% CI: 6.6–14.1) for the high prevalence and 2.4 (95% CI: 1.4–4.1) for the medium prevalence postcodes. Conclusion: A substantial concentration of the burden of anal cancer occurred among areas where large proportions of homosexual men reside. These results should guide the prioritisation of health service investment in anal cancer treatment and prevention to appropriate geographical areas.
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Holt M, Rawstorne P, Wilkinson J, Worth H, Bittman M, Kippax S. HIV testing, gay community involvement and internet use: social and behavioural correlates of HIV testing among Australian men who have sex with men. AIDS Behav 2012; 16:13-22. [PMID: 21213035 DOI: 10.1007/s10461-010-9872-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A significant minority of Australian men who have sex with men (MSM) have never been tested for HIV and many men do not test as often as recommended. Using data from 1770 HIV-negative and untested MSM collected in a national, online survey, we compared men who had never tested for HIV with those who had tested over 12 months ago and men who had tested over 12 months ago with those that had tested in the past year. Two multivariate logistic regression models were constructed. Compared with men tested over 12 months ago, untested men were younger, less educated, less likely to have unprotected anal intercourse with a regular male partner, less likely to have sought advice from a doctor, nurse or community organisation, more likely to expect HIV-negative disclosure, had fewer gay friends and spent more time using social networking websites. Compared with men who had tested over 12 months ago, men who had tested within the last year were younger, more likely to expect HIV-negative disclosure and disclose to casual partners, more likely to have sought advice from a doctor or nurse, had attended gay pools, gyms or beaches and had more gay friends and more male sex partners. Our findings suggest that the Internet and sex education in schools are important ways to promote HIV testing to untested MSM. Testing reinforcement messages delivered through gay community outreach and primary care will reach previously tested MSM.
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Affiliation(s)
- M Holt
- National Centre in HIV Social Research, The University of New South Wales, Sydney, Australia.
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Bourne C, Zablotska I, Williamson A, Calmette Y, Guy R. Promotion and uptake of a new online partner notification and retesting reminder service for gay men. Sex Health 2012; 9:360-7. [DOI: 10.1071/sh11132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 01/30/2012] [Indexed: 11/23/2022]
Abstract
Background In 2006, two new innovative features were added to a website called WhyTest which provided HIV/sexually transmissable infection (STI) information for gay men. The features were the ‘Tell them’ service allowing visitors to forward anonymous e-postcard or short message services (SMS) to sexual partners who may have been exposed to an STI, and the ‘Remind me’ service allowing visitors to register for a 3-, 6- or 12-monthly SMS reminder for a sexual health check. We describe the uptake of the new website functionality, and recognition of a health promotion campaign conducted in January–June 2007 to promote these new features. Methods: We used Poisson regression to assess trends in monthly partner notification messages and STI testing reminders sent in August 2007–June 2010. We also analysed 2007 Sydney Gay Community Periodic Survey data to measure recall of the campaign. Results: A total of 7923 partner notification messages were sent in the period August 2007–June 2010, with a significant increasing trend in monthly messages sent (P < 0001). Of the total messages sent, 7581 (96%) were by SMS and 342 (4%) by e-postcards. A total of 1023 STI testing reminders were sent in the same period, with a significant increasing trend in monthly reminders sent (P < 0.001); 516 reminders were by SMS (50.4%) and 507 by email (49.6%). The 2007 Sydney Gay Community Periodic Survey showed that 55% of the 2342 participants recognised the WhyTest image in the campaign. Conclusion: There was high awareness of WhyTest campaign images and the SMS partner notification service was more popular than the e-postcard feature.
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