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Takeuchi J, Chan C, MacGibbon J, Broady TR, Lea T, Mao L, Bavinton BR, Holt M. Trends in illicit drug use and their association with HIV transmission risks from behavioural surveillance of Australian gay and bisexual men. Drug Alcohol Rev 2024; 43:539-550. [PMID: 38010830 DOI: 10.1111/dar.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/22/2023] [Accepted: 10/29/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Investigating drug trends among Australian gay and bisexual men (GBM) is crucial for understanding levels of use and the potential for harm, including HIV transmission risk. METHOD Using repeated, national, cross-sectional survey data collected between 2012 and 2021 (69,567 surveys), trends of recent (previous 6 months) and frequent (weekly) drug use were analysed, using logistic regression models. The last round of data from each jurisdiction (6709 surveys) was used to compare GBM who reported no use, infrequent (less than weekly) use and frequent (at least weekly) use of party drugs to investigate the association between party drug use and HIV transmission risk, using multinomial logistic regression models. RESULTS There was a significant upward trend in any recent drug use (from 58.4% in 2012 to 64.1% in 2021; p < 0.001). Frequent party drug use remained a minority practice over the period (consistently less than 3%). In cross-sectional analysis, frequent party drug users were more likely to report behaviours with HIV transmission risks, such as condomless anal intercourse without biomedical prevention strategies (30.0% vs. 13.1%; adjusted relative risk ratio [aRRR], 2.08; 95% CI, 1.24-3.47), weekly group sex (16.3% vs. 0.6%; aRRR, 12.36; 95% CI, 5.75-26.56) and more than 20 recent sexual partners (42.5% vs. 5.0%; aRRR, 21.44; 95% CI, 5.82-78.89), compared with GBM who did not use party drugs. DISCUSSION AND CONCLUSION Our findings suggest that the frequent use of party drugs remains a marker of HIV transmission risk among Australian GBM, despite the increased adoption of biomedical HIV prevention strategies over the past few years.
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Affiliation(s)
- Jumpei Takeuchi
- School of Clinical Medicine, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Curtis Chan
- The Kirby Institute, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
| | - Toby Lea
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, Faculty of Arts, Design & Architecture, UNSW Sydney, Sydney, Australia
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Yu S, Bavinton BR, Chan C, MacGibbon J, Mao L, Vujcich D, Broady TR, Holt M. Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019-2021. J Int AIDS Soc 2024; 27:e26204. [PMID: 38193629 PMCID: PMC10775631 DOI: 10.1002/jia2.26204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Overseas-born gay and bisexual men (GBM) are overrepresented in HIV diagnoses in Australia. We assessed social and sexual behaviours, and the use of HIV prevention and testing, by region of birth and length of residence in Australia. We sought to identify similarities and differences between recently arrived and non-recently arrived GBM from non-English-speaking countries to improve targeting and engagement with HIV testing and prevention. METHODS Data were collected in national repeated, behavioural surveillance surveys conducted across Australia during 2019-2021. Logistic regression was used to identify factors that differentiated between recently arrived (<2 years) and non-recently arrived (≥2 years in Australia) GBM from non-English-speaking countries. RESULTS Among 24,707 participants in 2019-21, 2811 (11.4%) were from high-income English-speaking countries, 714 (2.9%) were recently arrived overseas-born GBM and 3833 (15.5%) were non-recently arrived migrants. Recently arrived GBM were most likely to be born in Asia (36.1%) and Europe (21.1%). Compared with non-recently arrived GBM, recently arrived GBM from non-English-speaking countries were younger (aOR = 0.95, 95% CI = 0.94-0.96, p<0.001), more likely to be students (aOR = 1.43, 95% CI = 1.11-1.85, p = 0.005), less likely to be in full-time employment (aOR = 0.56, 95% CI = 0.46-0.69, p <0.001), more likely to report consistent condom use (aOR = 1.30, 95% CI = 1.01-1.66, p = 0.039), but had lower awareness (aOR = 0.62, 95% CI = 0.48-0.80, p<0.001) and use of pre-exposure prophylaxis (PrEP) (22.8%, vs. 32.3%, χ2 (1, 4185) = 23.78, p<0.001), and similar levels of casual sex with a risk of HIV acquisition or transmission (aOR = 1.29, 95% CI = 0.98-1.69, p = 0.066). Recently arrived GBM reported similar levels of lifetime HIV testing (aOR = 0.97, 95% CI = 0.54-1.74, p = 0.915) and recent HIV testing (OR = 1.03, 95% CI = 0.86-1.22, p = 0.779), but were much less likely to have tested at general practitioners (aOR = 0.53, 95% CI = 0.41-0.68, p<0.001) and more likely to report testing at hospitals (aOR = 3.35, 95% CI = 2.53-4.43, p<0.001), at home (aOR = 2.85, 95% CI = 1.63-4.99, p<0.001), or community-based services (aOR = 1.36, 95% CI = 1.01-1.84, p = 0.043). CONCLUSIONS Recently arrived GBM from non-English-speaking countries reported similar levels of risk of HIV acquisition to longer-term residents in Australia, but lower levels of PrEP awareness and use, and more reliance on HIV testing services which are free or low cost. It is necessary to enhance access to HIV testing and prevention among recently arrived GBM in Australia.
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Affiliation(s)
- Simin Yu
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjamin R Bavinton
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Curtis Chan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - James MacGibbon
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Vujcich
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Factors Associated With Willingness to Use Daily Antibiotics as Sexually Transmitted Infection Prophylaxis Among HIV Preexposure Prophylaxis-Experienced Gay and Bisexual Men in Australia. Sex Transm Dis 2023; 50:144-149. [PMID: 36730780 DOI: 10.1097/olq.0000000000001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gay and bisexual men (GBM) who use HIV preexposure prophylaxis (HIV-PrEP) have high rates of bacterial sexually transmitted infections (STIs). The use of daily antibiotics as STI preexposure prophylaxis (STI-PrEP) may be appealing to GBM who are using or have previously used HIV-PrEP (HIV-PrEP-experienced) for the prevention of bacterial STIs. METHODS We examined willingness to use daily STI-PrEP among a cross-sectional sample of HIV-PrEP-experienced GBM in Australia who participated in an observational online cohort study from August 2018 to March 2020. Factors associated with willingness to use daily STI-PrEP were determined using bivariate and multivariate logistic regression. RESULTS Of the 1347 participants, half (54.3%) were willing to use daily STI-PrEP. Factors independently associated with greater willingness to use daily STI-PrEP included having >10 sexual partners in the last 6 months, using methamphetamine in the last 6 months, being more conscious about avoiding STIs, having a greater number of STIs since commencing HIV-PrEP, being willing to take HIV-PrEP for as long as they were at risk of acquiring HIV, and only using condoms when a sexual partner requested them. Conversely, factors associated with less willingness to use daily STI-PrEP included being university educated, using nondaily dosing regimens of HIV-PrEP, preferring event-driven HIV-PrEP, and being concerned about long-term HIV-PrEP adverse effects. CONCLUSIONS Sexually transmitted infection PrEP is likely to be appealing to many HIV-PrEP-experienced GBM, especially those who engage in activities associated with a higher risk of STI transmission. However, they are less likely to be willing to use STI-PrEP unless it aligns with their HIV-PrEP dosing regimen, suggesting that research into the safety and efficacy of alternative STI prophylaxis dosing options should be prioritized.
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Holt M, Chan C, Broady TR, Mao L, MacGibbon J, Rule J, Wilcock B, Prestage G, Bavinton BR. Adjusting Behavioural Surveillance and Assessing Disparities in the Impact of COVID-19 on Gay and Bisexual Men's HIV-Related Behaviour in Australia. AIDS Behav 2023; 27:518-534. [PMID: 35895148 PMCID: PMC9326145 DOI: 10.1007/s10461-022-03788-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
COVID-19 has disrupted sexual behaviour and access to health systems. We adapted regular HIV behavioural surveillance of gay and bisexual men (GBM) in Australia in response to COVID-19, assessed the impact on the profile of the sample, the participants' HIV-related behaviour, and whether COVID-19 may have accentuated existing disparities in the Australian HIV epidemic. Data collected from five states during July 2017-June 2021 were included (N = 31,460). The emphasis on online recruitment after COVID-19 led to smaller sample sizes, greater geographic reach, and a higher proportion of bisexual-identifying participants. Most participants (88.1%) reported physical distancing and 52.1% had fewer sex partners due to COVID-19. In the COVID-19-affected rounds (July 2020-June 2021), the number of male partners, recent HIV testing and pre-exposure prophylaxis (PrEP) use all fell, and HIV risk among the smaller group of participants who reported casual sex increased. COVID-related changes were generally more pronounced among GBM aged under 25 years, participants from suburbs with fewer gay residents, and bisexual men. These groups should be prioritised when encouraging GBM to reengage with HIV testing services and effective prevention methods, like condoms and PrEP.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, Australia
| | - Ben Wilcock
- Australian Federation of AIDS Organisations, Sydney, Australia
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Chan C, Bavinton BR, Prestage GE, Broady TR, Mao L, Rule J, Wilcock B, Holt M. Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998-2020. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2509-2521. [PMID: 35672592 PMCID: PMC9293873 DOI: 10.1007/s10508-022-02310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 05/30/2023]
Abstract
Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.
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Affiliation(s)
- Curtis Chan
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia.
| | - Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Garrett E Prestage
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, Australia
| | - Ben Wilcock
- Australia Federation of AIDS Organisations, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Saxby K, Chan C, Bavinton BR. Structural Stigma and Sexual Health Disparities Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia. J Acquir Immune Defic Syndr 2022; 89:241-250. [PMID: 34723923 DOI: 10.1097/qai.0000000000002851] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Discrimination and stigmatization at the institutional and sociocultural level (conceptualized as "structural stigma") has been associated with adverse health outcomes among sexual and gender minorities. However, few studies explore whether structural stigma is associated with sexual health outcomes. Addressing this gap, here, we explore this relationship among Australian gay, bisexual, and other men who have sex with men (GBM)-a population disproportionately affected by HIV. SETTING AND METHODS Using responses from the 2017 Australian Marriage Law Postal Survey, we operationalized structural stigma related to sexual minority status as the regional percentage of votes against legalizing same-sex marriage. These responses were then linked to national HIV behavioral surveillance data from Australian GBM (43,811 responses between 2015 and 2019). Controlling for a rich set of individual and regional level confounders, regression analyses were used to estimate the extent to which structural stigma was associated with testing for, and diagnoses of, HIV and sexually transmitted infections (STIs), and awareness and use of HIV prevention and treatment interventions (pre-exposure and postexposure prophylaxis, combination therapy, and HIV-related clinical care). RESULTS Australian GBM living in regions with higher levels of structural stigma were less likely to undergo HIV/STI testing, receive HIV/STI diagnoses, and be taking, or aware of, biomedical prevention strategies. Among GBM living with HIV, structural stigma was associated with a reduced likelihood of being on combination therapy and fewer HIV-related clinical visits. CONCLUSIONS Altogether, these results suggest that structural stigma may undermine HIV prevention strategies as well as adequate management of HIV infection among GBM.
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Affiliation(s)
- Karinna Saxby
- Centre for Health Economics, Monash Business School, Monash University, Victoria, Australia ; and
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Bavinton BR, Chan C, Hammoud MA, Maher L, Haire B, Degenhardt L, Holt M, Lea T, Bath N, Storer D, Jin F, Grulich AE, Bourne A, Saxton P, Prestage GP. Increase in Depression and Anxiety Among Australian Gay and Bisexual Men During COVID-19 Restrictions: Findings from a Prospective Online Cohort Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:355-364. [PMID: 35039984 PMCID: PMC8763302 DOI: 10.1007/s10508-021-02276-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 06/02/2023]
Abstract
We examined depression and anxiety prior to and during COVID-19 restrictions in Australian gay and bisexual men (GBM). In an online cohort, a COVID-19-focused survey was conducted in April 2020. During 2019 and in April 2020, 664 GBM completed the Patient Health Questionnaire (PHQ-9, measuring depression) and Generalized Anxiety Disorder Assessment (GAD-7, measuring anxiety). Increased depression and anxiety were defined as a ≥ 5 point increase on the respective scales. Mean PHQ-9 and GAD-7 scores increased between 2019 and 2020 (PHQ-9: from 5.11 in 2019 to 6.55 in 2020; GAD-7: from 3.80 in 2019 to 4.95 in 2020). The proportion of participants with moderate-severe depression (PHQ-9 ≥ 10) increased from 18.8% (n = 125) to 25.5% (n = 169), while the proportion of participants with moderate-severe anxiety (GAD-7 ≥ 10) increased from 12.7% (n = 84) to 17.3% (n = 115). Almost one-quarter of participants (n = 158, 23.8%) had increased depression; in these men, mean PHQ-9 increased from 2.49 in 2019 to 11.65 in 2020 (p < 0.001). One-in-five (20.6%) participants (n = 137) had increased anxiety; among these men, mean GAD-7 increased from 2.05 in 2019 to 10.22 in 2020 (p < 0.001). Increases were associated with concerns about job security, reduction in social and sexual connections and opportunities, and being personally concerned about COVID-19 itself. COVID-19 appeared to have a sudden and pronounced impact on depression and anxiety in Australian GBM, with a significant minority showing sharp increases. Ongoing monitoring is required to determine longer-term impacts and GBM need access to appropriate and sensitive supports both during and after the COVID-19 pandemic.
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Affiliation(s)
- Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Curtis Chan
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Mohamed A Hammoud
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Bridget Haire
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Nicky Bath
- National LGBTI Health Alliance, Sydney, NSW, Australia
| | - Daniel Storer
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Fenyi Jin
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Andrew E Grulich
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Peter Saxton
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Garrett P Prestage
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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Estimation of Potential HIV Transmission Risk in Recent Anal Intercourse Events among Men Who Have Sex with Men and Transgender Women in Bali, Indonesia. Trop Med Infect Dis 2021; 6:tropicalmed6030139. [PMID: 34449742 PMCID: PMC8396300 DOI: 10.3390/tropicalmed6030139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/07/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
In recent years, prevalence of Human Immunodeficiency Virus (HIV) has increased substantially in Bali, Indonesia, in men who have sex with men (MSM) and transgender women, known locally as ‘waria’. There are limited behavioural data in this population. We conducted a behavioural survey of MSM/waria in Bali in March–April 2018. Respondents were primarily recruited by HIV outreach workers. Respondents reported details about anal intercourse events with their last male/waria romantic partner and/or last male/waria casual partner (respondents could report on both if relevant). Statistical significance was tested with generalised estimating equations. Among 709 participants, median age was 27 (interquartile range = 24–31), and 92.1% were male and 7.9% were waria. One-third were born in Bali. Overall, 85.9% had ever had an HIV test; 55.1% reported being HIV-negative, 15.0% HIV-positive, and 30.0% had unknown serostatus. Most (86.5%) reported sex with men, 9.5% with waria, and 20.0% with women in the previous 6 months. Respondents described 703 anal intercourse events (397/306 with romantic/casual partners, respectively; 191 reported on both). Over half (56.5%) of the events were protected by condoms and 7.3% by biomedical prevention (2.6% by PrEP in either partner, 4.7% by HIV treatments in either partner). Thus, 36.3% of events involved unprotected condomless anal intercourse (40.8%/30.4% in romantic/casual partners, respectively). In multivariate analysis, unprotected condomless anal intercourse events were associated with romantic partners (p < 0.001), being born in Bali (p = 0.002), lower education (p = 0.013), believing that withdrawal before ejaculation is effective (p < 0.001), liking to use withdrawal (p = 0.021), and not liking condoms (p < 0.001). One-quarter of events had potentially reduced HIV transmission risk through non-condom-based risk reduction strategies, while 11.1% had no potential risk reduction. Events presenting the highest potential risk of HIV transmission were more commonly reported by respondents born in Bali.
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Sustained, Low Prevalence of Undiagnosed HIV Among Gay and Bisexual Men in Sydney, Australia Coincident With Increased Testing and Pre-exposure Prophylaxis Use: Results From Repeated, Bio-Behavioral Studies 2014-2018. J Acquir Immune Defic Syndr 2021; 85:e41-e47. [PMID: 32694388 DOI: 10.1097/qai.0000000000002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gay and bisexual men with undiagnosed HIV contribute disproportionately to HIV transmission in Australia. METHODS In 2014 and 2018, we recruited men at gay venues and events in Sydney. Participants self-completed surveys and provided oral fluid samples for HIV testing. We calculated the prevalence of HIV and undiagnosed infection, and assessed changes in behavior, HIV testing, and the use of pre-exposure prophylaxis. We weighted the samples to adjust for differences in where participants were recruited between rounds. Two-sample tests of proportion were used to compare prevalence estimates and χ tests to assess differences between the samples. RESULTS In 2014, 944 men were recruited, and 890 men were recruited in 2018. In 2014, the weighted estimate of HIV prevalence was 6.1% [95% confidence intervals (CI): 4.6 to 7.6], of which 13.8% (95% CI: 5.0 to 22.7) was undiagnosed. In 2018, weighted HIV prevalence was 6.4% (95% CI: 4.8 to 8.0), of which 5.3% (95% CI: 0.5 to 11.1) was undiagnosed. Between 2014 and 2018 among all participants, men reporting at least 10 recent casual partners increased from 22.3% to 27.7% (P = 0.008), condomless anal intercourse with casual partners in the previous 6 months increased from 23.9% to 37.3% (P < 0.001), and sexually transmitted infection diagnoses in the previous year increased from 14.4% to 27.5% (P < 0.001). HIV testing and the use of pre-exposure prophylaxis in the previous 6 months increased from 49.6% to 56.3% (P = 0.004) and 2.0%-21.0% (P < 0.001), respectively. CONCLUSIONS Repeated, bio-behavioral surveillance suggests the prevalence of undiagnosed HIV remains low in Sydney, despite gay and bisexual men reporting more casual sex partners, condomless sex, and sexually transmitted infections.
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Broady TR, Bavinton BR, Mao L, Prestage G, Holt M. Australian Gay and Bisexual Men Who Use Condoms, PrEP or Rarely Practise HIV Risk Reduction with Casual Sex Partners: An Analysis of National, Behavioural Surveillance Data, 2017-2018. AIDS Behav 2020; 24:3501-3510. [PMID: 32444902 DOI: 10.1007/s10461-020-02928-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recent increases in the availability of pre-exposure prophylaxis (PrEP) internationally have widened the range of HIV prevention strategies available to gay and bisexual men. This paper aimed to quantify the use of different risk reduction strategies and compare characteristics of men who rarely use any strategies with those who regularly use condoms or PrEP. Using national cross-sectional data from the Gay Community Periodic Surveys in Australia, comparisons were made between regular condom users (37.1% of participants), PrEP users (50.1%), and men who infrequently used any risk reduction strategies (12.8%). The proportion of gay and bisexual men reporting infrequent use of HIV risk reduction strategies has decreased in recent years. These men reported less frequent high-risk sexual practices than PrEP users and also reported less recent HIV testing than either PrEP or condom users. Men who infrequently use HIV risk reduction strategies should be encouraged to test for HIV more regularly and to utilise prevention strategies that align with their infrequent high-risk behaviour.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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Increases in HIV Testing Frequency in Australian Gay and Bisexual Men are Concentrated Among PrEP Users: An Analysis of Australian Behavioural Surveillance Data, 2013-2018. AIDS Behav 2020; 24:2691-2702. [PMID: 32162094 DOI: 10.1007/s10461-020-02826-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Increasing HIV testing frequency in gay and bisexual men (GBM) is critical to reducing the time between HIV infection and diagnosis. Using anonymous national behavioural surveillance data (2013-2018) from 43,753 surveys of Australian GBM, we examined HIV testing frequency trends and factors differentiating PrEP-users, non-PrEP-users reporting two or more tests in the previous year, and non-PrEP-users reporting less frequent testing. The proportion tested at least annually increased from 64.4% in 2013 to 70.8% in 2018 (p-trend < 0.001), and from 73.9% to 84.6% among the 51.6% of men classified as higher-risk. Among higher-risk men, having two or more tests in the previous year increased from 48.0% to 69.3% (p-trend < 0.001). Among higher-risk non-PrEP-users, it increased from 47.2% to 54.8% (p-trend < 0.001), however, there was a decrease since 2016 (p-trend < 0.001). Among PrEP-users, it increased from 82.1% in 2013 to 97.3% in 2018 (p-trend < 0.001). Non-PrEP-using higher-risk men having less frequent tests reported lower risk than PrEP-users and non-PrEP-using men reporting two or more tests in the previous year. However, recent risk behaviour was not uncommon: nearly half reported condomless sex; one-fifth reported receptive condomless sex with ejaculation; over half reported group sex; one-quarter used drugs for the purposes of sex; and one-fifth had more than ten sex partners. Efforts are needed to encourage frequent testing and PrEP use among non-PrEP-users who are at higher-risk.
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Chan C, Broady TR, Bavinton BR, Mao L, Prestage GP, Holt M. Assessing the HIV Prevention Needs of Young Gay and Bisexual Men in the PrEP Era: An Analysis of Trends in Australian Behavioural Surveillance, 2014-2018. AIDS Behav 2020; 24:2382-2386. [PMID: 31974723 DOI: 10.1007/s10461-020-02797-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Data from repeated, national behavioural HIV surveillance was used to identify similarities and differences between young gay and bisexual men (YGBM) aged 16-24 (n = 1608) and older GBM aged 25-49 (n = 6266), in order to quantify risks and identify gaps in HIV prevention. Trend analyses from 2014 to 2018 are also reported. While there were similar rates of condomless anal intercourse with casual partners in both age groups, YGBM had lower rates of HIV testing and PrEP use but also fewer male partners. Our results suggest most YGBM have lower HIV risk than older GBM but a minority merit enhanced testing and prevention efforts.
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Gay Men's Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data. AIDS Behav 2020; 24:1389-1399. [PMID: 31745684 DOI: 10.1007/s10461-019-02737-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Using repeated, cross-sectional behavioural surveillance data from Australia, we assessed trends in relationship agreements and casual sex among HIV-negative and untested gay and bisexual men who had regular partners during 2013-2018. We conducted three analyses: (i) trends in relationship agreements and casual sex over time; (ii) bivariate comparisons of PrEP users and non-PrEP-users to identify factors associated with PrEP use; and (iii) multivariate logistic regression to identify factors independently associated with PrEP use. The analysis of trends over time included 21,593 men, from which a sub-sample (n = 3764) was used to compare PrEP users and non-PrEP-users. We found a large increase in agreements that allowed condomless sex with casual partners, particularly by PrEP users in relationships (nearly 40% of whom had such an agreement). A further 34% of PrEP users reported having casual condomless sex without an agreement that permitted that behaviour, while 13% of non-PrEP-users also reported condomless sex with casual partners without an agreement. PrEP use was independently associated with having agreements permitting condomless sex with casual partners, recent condomless sex with casual partners, having greater numbers of male partners, recent post-exposure prophylaxis use, having an HIV-positive regular male partner, and recent condomless sex with regular male partners. Our findings show a shift away from relationship agreements in which condomless sex was only sanctioned between regular partners.
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Lee E, Mao L, Bavinton B, Prestage G, Holt M. Which Gay and Bisexual Men Attend Community-Based HIV Testing Services in Australia? An Analysis of Cross-Sectional National Behavioural Surveillance Data. AIDS Behav 2020; 24:387-394. [PMID: 30863977 DOI: 10.1007/s10461-019-02435-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In Australia, HIV testing services have become increasingly available in non-traditional settings such as peer-led, community-based services to expand access and increase uptake of HIV testing among gay and bisexual men (GBM). This study aimed to compare the socio-demographic and behavioural characteristics of GBM whose last HIV test was conducted at a community-based service to GBM whose last test was at a traditional clinical setting. We analysed behavioural surveillance data collected from 5988 participants in seven states and territories in the period 2016-2017. We found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings, particularly in terms of sexual practice and risk of HIV. However, non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study points to the successful establishment of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV.
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Affiliation(s)
- Evelyn Lee
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ben Bavinton
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
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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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Holt M, Lea T, Mao L, Zablotska I, Lee E, de Wit JBF, Prestage G. Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys. Sex Health 2019; 14:72-79. [PMID: 27567489 DOI: 10.1071/sh16072] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022]
Abstract
Background In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission. METHODS The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia's primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000-15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. RESULTS Between 2000 and 2015, there were significant increases (P<0.001) in annual HIV testing (56.1-64.8%), condomless sex with casual partners (26.8-38.8%) and the proportion of HIV-positive men on HIV treatment (72.5-88.4%) and with an undetectable viral load (73.7-94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. CONCLUSIONS Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.
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Affiliation(s)
- Martin Holt
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Toby Lea
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Limin Mao
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Iryna Zablotska
- The University of New South Wales, The Kirby Institute, Sydney, NSW 2052, Australia
| | - Evelyn Lee
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - John B F de Wit
- The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia
| | - Garrett Prestage
- The University of New South Wales, The Kirby Institute, Sydney, NSW 2052, Australia
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Jamil MS, Guy RJ, Bavinton BR, Fairley CK, Grulich AE, Holt M, Smith KS, Chen M, McNulty AM, Conway DP, Keen P, Bradley J, Russell D, Kaldor JM, Prestage G. HIV testing self-efficacy is associated with higher HIV testing frequency and perceived likelihood to self-test among gay and bisexual men. Sex Health 2019; 14:170-178. [PMID: 27883311 DOI: 10.1071/sh16100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 10/05/2016] [Indexed: 11/23/2022]
Abstract
Background Regular testing of individuals at higher-risk of HIV is central to current prevention strategies. The aim of the present study was to examine the extent to which confidence in one's perceived ability to undertake various aspects of HIV testing and self-testing (self-efficacy) affected HIV testing outcomes. We assessed factors, including self-efficacy, associated with HIV testing frequency and the likelihood to self-test among gay and bisexual men (GBM). METHODS Participants were HIV-negative GBM at an increased risk of HIV (more than five partners or condomless anal intercourse in the previous 3 months) enrolled in a randomised controlled trial of HIV self-testing. The baseline questionnaire captured data regarding sociodemographic characteristics, HIV and/or sexually transmissible infection testing history, sexual behaviour, beliefs and attitudes towards HIV and eight items capturing confidence in HIV testing ability that were combined as a single broad measure of HIV testing self-efficacy (α=0.81). Factors associated with three or more HIV tests in the past year and the likelihood of self-testing in the future were determined using logistic regression. RESULTS Of 354 GBM, 34% reported three or more HIV tests in the past year, and 64% reported being 'very likely' to self-test. Factors independently associated with three or more HIV tests in the past year were: higher self-efficacy (adjusted odds ratio (aOR) 1.08 per unit increase; 95% confidence interval (CI) 1.02-1.14; P=0.004); >10 male partners in the past 6 months (aOR 1.79; 95% CI 1.05-3.04; P=0.031) and higher optimism regarding the effects of HIV treatments on HIV transmission (aOR 1.14; 95% CI 1.00-1.29; P=0.044). Only higher self-efficacy was independently associated with reporting a greater likelihood to self-test in the future (aOR 1.10; 95% CI 1.05-1.15; P < 0.001). CONCLUSIONS Improving self-efficacy by enhancing GBM's knowledge and experience may lead to higher testing frequency. The self-efficacy measure used in the present study could be useful in identifying GBM likely to face difficulties with HIV testing and self-testing.
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Affiliation(s)
- Muhammad S Jamil
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Benjamin R Bavinton
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia
| | - Andrew E Grulich
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Goodsell Building, Sydney, NSW 2052, Australia
| | - Kirsty S Smith
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia
| | - Anna M McNulty
- Sydney Sexual Health Centre, Nightingale Wing, Sydney Hospital, Macquarie street, Sydney, NSW 2000, Australia
| | - Damian P Conway
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Phillip Keen
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Jack Bradley
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Darren Russell
- Cairns Sexual Health Service, 381 Sheridan Street, Cairns North, Qld 4870, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW 2052, Australia
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Zablotska IB, Gray R, Whittaker B, Holt M, Wright E, Prestage G, O’Donnell D, Grulich AE. The estimated number of potential PrEP users among gay-identifying men who have sex with men in Australia. PLoS One 2018; 13:e0204138. [PMID: 30335758 PMCID: PMC6193616 DOI: 10.1371/journal.pone.0204138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/03/2018] [Indexed: 11/22/2022] Open
Abstract
We estimated the size of the population of gay-identified men who have sex with men (gay men) eligible for PrEP in Australia under the current national PrEP guidelines. Using input indicators from the Australian Bureau of Statistics, the national representative survey Second Australian Study of Health and Relationships, and national HIV- behavioural surveillance, we calculated the size of the population of sexually active gay men and estimated a range for the number eligible for PrEP using different scenarios based on the guidelines. In 2015, an estimated 108,850 sexually-active 16-69-year-old gay men were classified as at risk of acquiring HIV in Australia. Of these men, 10,558 to 30,913 (9.7%-28.4%) were classified as being at high risk and therefore eligible for PrEP, most commonly due to recent receptive condomless intercourse with casual partners (6.1% to 15.5%), STI infections (5.4% to 10.6%) or the use of crystal methamphetamine (1.4% to 9.4%). The higher estimates included men who may have been at HIV risk for shorter time periods or with fewer partners. Australian PrEP guidelines recommend targeting PrEP to people at high HIV risk. Our estimation of potential PrEP users informed PrEP implementation in Australia. The choice of PrEP eligibility criteria, and interpretation of the guidelines, strongly affects the population estimates. In the future, higher numbers of gay men may become eligible for PrEP, because the estimates are largely defined by and follow trends in condomless anal intercourse. Our estimation methods can be adapted to other settings.
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Affiliation(s)
- Iryna B. Zablotska
- Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Richard Gray
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Bill Whittaker
- National Association of People with HIV, Newtown, New South Wales, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Edwina Wright
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Garrett Prestage
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Darryl O’Donnell
- Australian Federation of AIDS Organisations, Newtown, New South Wales, Australia
| | - Andrew E. Grulich
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013–17. LANCET HIV 2018; 5:e448-e456. [DOI: 10.1016/s2352-3018(18)30072-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 11/19/2022]
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20
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Bui H, Zablotska-Manos I, Hammoud M, Jin F, Lea T, Bourne A, Iversen J, Bath N, Grierson J, Degenhardt L, Prestage G, Maher L. Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: Results from the FLUX study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 55:222-230. [DOI: 10.1016/j.drugpo.2018.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/12/2018] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
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Mirzazadeh A, Shokoohi M, Navadeh S, Danesh A, Jain J, Sedaghat A, Farnia M, Haghdoost A. Underreporting in HIV-related high-risk behaviors: comparing the results of multiple data collection methods in a behavioral survey of prisoners in Iran. THE PRISON JOURNAL 2018; 98:213-228. [PMID: 30078913 PMCID: PMC6075723 DOI: 10.1177/0032885517753163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We explored the potentials of using three indirect methods including crosswise, proxy respondent method, and network scale-up (NSU) in comparison to direct questioning in collecting sensitive and socially stigmatized HIV-related risk behaviors information from prisoners (N=265). Participants reported more sexual contact in prison for their friends than they did for themselves (10.6% vs. 3.8% in men, 13.7% vs. 0% in women). In men, NSU provided lower estimates than direct questioning, while in women NSU estimates were higher. Different data collection methods provide different estimates, and collectively offer a more comprehensive picture of HIV-related risk behaviors in prisons.
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Affiliation(s)
- Ali Mirzazadeh
- Global Health Sciences, University of California, San Francisco California; San Francisco, CA USA
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shokoohi
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Soodabeh Navadeh
- Global Health Sciences, University of California, San Francisco California; San Francisco, CA USA
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Danesh
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health and Community Medicine, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Jennifer Jain
- Global Health Sciences, University of California, San Francisco California; San Francisco, CA USA
| | - Abbas Sedaghat
- HIV National Program, Center for Disease Control, Ministry of Health, Tehran, Iran
| | - Marziyeh Farnia
- Health and Treatment Office of Iranian Prisons Organization, Tehran, Iran
| | - AliAkbar Haghdoost
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Zablotska IB, Selvey C, Guy R, Price K, Holden J, Schmidt HM, McNulty A, Smith D, Jin F, Amin J, Cooper DA, Grulich AE. Expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in New South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health 2018; 18:210. [PMID: 29394918 PMCID: PMC5797394 DOI: 10.1186/s12889-017-5018-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/21/2017] [Indexed: 01/08/2023] Open
Abstract
Background The New South Wales (NSW) HIV Strategy 2016–2020 aims for the virtual elimination of HIV transmission in NSW, Australia, by 2020. Despite high and increasing levels of HIV testing and treatment since 2012, the annual number of HIV diagnoses in NSW has remained generally unchanged. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among gay and bisexual men (GBM) when taken appropriately. However, there have been no population-level studies that evaluate the impact of rapid PrEP scale-up in high-risk GBM. Expanded PrEP Implementation in Communities in NSW (EPIC-NSW) is a population-level evaluation of the rapid, targeted roll-out of PrEP to high-risk individuals. Methods EPIC-NSW, is an open-label, single-arm, multi-centre prospective observational study of PrEP implementation and impact. Over 20 public and private clinics across urban and regional areas in NSW have participated in the rapid roll-out of PrEP, supported by strong community mobilization and PrEP promotion. The study began on 1 March 2016, aiming to enroll at least 3700 HIV negative people at high risk of HIV. This estimate took into consideration criteria for PrEP prescription in people at high risk for acquiring HIV as defined in the NSW PrEP guidelines. Study participants receive once daily co-formulated tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and are followed for up to 24 months. Follow-up includes: testing for HIV at 1 month, HIV and other sexually transmissible infections three-monthly, HCV annually and monitoring of renal function six-monthly. Optional online behavioural surveys are conducted quarterly. The co-primary endpoints are (i) HIV diagnoses and incidence in the cohort and (ii) HIV diagnoses in NSW. Discussion EPIC-NSW is a population-based PrEP implementation trial which targets the entire estimated population of GBM at high risk for HIV infection in NSW. It will provide a unique opportunity to evaluate the population impact of PrEP on a concentrated HIV epidemic. Trial registration https://clinicaltrials.gov/ (identifying number NCT02870790; registration date 14 August 2016), pre-results stage. Electronic supplementary material The online version of this article (10.1186/s12889-017-5018-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
| | | | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Karen Price
- AIDS Council of New South Wales (ACON), Sydney, NSW, Australia
| | - Jo Holden
- NSW Ministry of Health, Sydney, NSW, Australia
| | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - David Smith
- Mid North Coast Local Health District (Area HIV/Sexual Health Services), Lismore Health Service, Lismore, NSW, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.,Macquarie University, Sydney, NSW, Australia
| | - David A Cooper
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
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Hess KL, Crepaz N, Rose C, Purcell D, Paz-Bailey G. Trends in Sexual Behavior Among Men Who have Sex with Men (MSM) in High-Income Countries, 1990-2013: A Systematic Review. AIDS Behav 2017; 21:2811-2834. [PMID: 28555317 PMCID: PMC5708163 DOI: 10.1007/s10461-017-1799-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV diagnoses among men who have sex with men (MSM) have been increasing in several high-income countries. A better understanding of the sexual behavior trends among MSM can be useful for informing HIV prevention. We conducted a systematic review of studies that examined behavioral trends (1990-2013) in any condomless anal sex, condomless anal sex with an HIV-discordant partner, and number of partners. Studies included come from the United States, Europe, and Australia. We found increasing trends in condomless anal sex and condomless anal sex with an HIV-discordant partner, and a decreasing trend in number of partners. The increase in condomless anal sex may help to explain the increase in HIV infections. More explanatory research is needed to provide insight into factors that contribute to these behavior trends. Continuous monitoring of HIV, risk behaviors, and use of prevention and treatment is needed to evaluate prevention efforts and monitor HIV transmission risk.
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Affiliation(s)
- Kristen L Hess
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA.
| | - Nicole Crepaz
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Charles Rose
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - David Purcell
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop E-47, Atlanta, GA, 30329, USA
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Stoové M, Asselin J, Pedrana A, Lea T, Hellard M, Wilson D, Prestage G, de Wit J, Holt M. Declining prevalence of undiagnosed HIV in Melbourne: results from community-based bio-behavioural studies of gay and bisexual men. Aust N Z J Public Health 2017; 42:57-61. [PMID: 28749540 DOI: 10.1111/1753-6405.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To measure changes in undiagnosed HIV among gay and bisexual men (GBM) in Melbourne. METHODS Undiagnosed HIV was compared between GBM recruited anonymously in 2008 in gay venues only and GBM anonymously or confidentially (results delivery) recruited in 2014 at gay venues and a community festival. Surveys were completed and oral fluid specimens collected for HIV testing; positive tests among GBM reporting being HIV-negative or unknown/untested were classified as undiagnosed. Tests of proportions compared serological prevalence, undiagnosed prevalence and participant characteristics. RESULTS HIV prevalence was 9.5% and 7.1% among 639 and 993 GBM recruited in 2008 and 2014, respectively; undiagnosed prevalence declined significantly from 31.1% to 7.1% (p<0.001). Sexual risk and undiagnosed HIV was highest among venue-recruited participants in 2014 (17.6%). Fewer diagnosed GBM participated confidentially in 2014, but this did not meaningfully influence comparative undiagnosed HIV prevalence. CONCLUSION We provide the first estimates of changes in undiagnosed HIV in Australia, demonstrating a marked decline in undiagnosed HIV among GBM. Implications for public health: Our findings are consistent with reports of increases in HIV testing among GBM. Given sustained high HIV diagnosis rates, new testing models that encourage high frequency testing are needed to control the local HIV epidemic.
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Affiliation(s)
- Mark Stoové
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - Jason Asselin
- Centre for Population Health, Burnet Institute, Victoria
| | - Alisa Pedrana
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - Toby Lea
- Centre for Social Research in Health, UNSW, New South Wales
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Victoria.,School of Population Health and Preventive Medicine, Monash University, Alfred Hospital, Victoria
| | - David Wilson
- Centre for Population Health, Burnet Institute, Victoria.,Kirby Institute, UNSW, New South Wales
| | | | - John de Wit
- Centre for Social Research in Health, UNSW, New South Wales
| | - Martin Holt
- Centre for Social Research in Health, UNSW, New South Wales
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Jamil MS, Prestage G, Fairley CK, Grulich AE, Smith KS, Chen M, Holt M, McNulty AM, Bavinton BR, Conway DP, Wand H, Keen P, Bradley J, Kolstee J, Batrouney C, Russell D, Law M, Kaldor JM, Guy RJ. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. Lancet HIV 2017; 4:e241-e250. [PMID: 28219619 DOI: 10.1016/s2352-3018(17)30023-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 12/04/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frequent testing of individuals at high risk of HIV is central to current prevention strategies. We aimed to determine if HIV self-testing would increase frequency of testing in high-risk gay and bisexual men, with a particular focus on men who delayed testing or had never been tested before. METHODS In this randomised trial, HIV-negative high-risk gay and bisexual men who reported condomless anal intercourse or more than five male sexual partners in the past 3 months were recruited at three clinical and two community-based sites in Australia. Enrolled participants were randomly assigned (1:1) to the intervention (free HIV self-testing plus facility-based testing) or standard care (facility-based testing only). Participants completed a brief online questionnaire every 3 months, which collected the number of self-tests used and the number and location of facility-based tests, and HIV testing was subsequently sourced from clinical records. The primary outcome of number of HIV tests over 12 months was assessed overall and in two strata: recent (last test ≤2 years ago) and non-recent (>2 years ago or never tested) testers. A statistician who was masked to group allocation analysed the data; analyses included all participants who completed at least one follow-up questionnaire. After the 12 month follow-up, men in the standard care group were offered free self-testing kits for a year. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613001236785. FINDINGS Between Dec 1, 2013, and Feb 5, 2015, 182 men were randomly assigned to self-testing, and 180 to standard care. The analysis population included 178 (98%) men in the self-testing group (174 person-years) and 165 (92%) in the standard care group (162 person-years). Overall, men in the self-testing group had 701 HIV tests (410 self-tests; mean 4·0 tests per year), and men in the standard care group had 313 HIV tests (mean 1·9 tests per year); rate ratio (RR) 2·08 (95% CI 1·82-2·38; p<0·0001). Among recent testers, men in the self-testing group had 627 tests (356 self-tests; mean 4·2 per year), and men in the standard care group had 297 tests (mean 2·1 per year); RR 1·99 (1·73-2·29; p<0·0001). Among non-recent testers, men in the self-testing group had 74 tests (54 self-tests; mean 2·8 per year), and men in the standard care group had 16 tests (mean 0·7 per year); RR 3·95 (2·30-6·78; p<0·0001). The mean number of facility-based HIV tests per year was similar in the self-testing and standard care groups (mean 1·7 vs 1·9 per year, respectively; RR 0·86, 0·74-1·01; p=0·074). No serious adverse events were reported during follow-up. INTERPRETATION HIV self-testing resulted in a two times increase in frequency of testing in gay and bisexual men at high risk of infection, and a nearly four times increase in non-recent testers, compared with standard care, without reducing the frequency of facility-based HIV testing. HIV self-testing should be made more widely available to help increase testing and earlier diagnosis. FUNDING The National Health and Medical Research Council, Australia.
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Affiliation(s)
| | | | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | | | - Kirsty S Smith
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Marcus Chen
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Anna M McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | | | - Damian P Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Handan Wand
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jack Bradley
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Colin Batrouney
- Victorian AIDS Council/Gay Men's Health Centre, Melbourne, VIC, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns North, QLD, Australia; James Cook University, Townsville, QLD, Australia
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
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26
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Deacon RM, Mooney-Somers J. Smoking prevalence among lesbian, bisexual and queer women in Sydney remains high: Analysis of trends and correlates. Drug Alcohol Rev 2017; 36:546-554. [PMID: 28211962 DOI: 10.1111/dar.12477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/09/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS To investigate smoking prevalence trends and correlates among lesbian, bisexual and queer-identifying (LBQ) women in Sydney, Australia. DESIGN AND METHODS Data from 5007 respondents to a repeated cross-sectional community survey were used to examine smoking trends between 2004 and 2014. Multinomial logistic regression was used to examine smoking correlates. RESULTS Thirty percent of respondents were current smokers, including 48% of 16 to 24-year-olds. A slight decrease in all-ages smoking over time was not reflected in the youngest age group. LBQ women who smoke have fewer economic, social and psychological resources than both women who never smoke and ex-smokers. High levels of alcohol and illicit drug use are also correlated with current smoking. DISCUSSION AND CONCLUSIONS Population-wide interventions have failed to address the persistently high prevalence of smoking among this sample of LBQ women. Tailored interventions may find utility focusing on personal resilience to deal with general and sexuality-specific stressors, as well as attending to poly-substance use. Acknowledgment of LBQ women as a priority group for tobacco reduction is urgently needed. We call on tobacco control agencies to consider sexuality and gender orientation in policy and partner with lesbian, gay, bisexual and transgender community organisations to develop culturally appropriate interventions. [Deacon RM, Mooney-Somers J Smoking prevalence among lesbian, bisexual and queer women in Sydney remains high: Analysis of trends and correlates Drug Alcohol Rev 2017;36:546-554].
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Affiliation(s)
- Rachel M Deacon
- The Langton Centre, South Eastern Sydney Local Health District, Sydney, Australia.,Central Clinical School, The University of Sydney, Sydney, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
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27
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Holt M, Lea T, Schmidt HM, Kolstee J, Ellard J, Murphy D, Truong HH, de Wit J. Willingness to use and have sex with men taking HIV pre-exposure prophylaxis (PrEP): results of online surveys of Australian gay and bisexual men, 2011-2015. Sex Transm Infect 2017; 93:438-444. [PMID: 28108701 DOI: 10.1136/sextrans-2016-052774] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/29/2016] [Accepted: 01/04/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Assess willingness to use HIV pre-exposure prophylaxis (PrEP), support for others using it and willingness to have sex with partners using PrEP among Australian gay and bisexual men (GBM). METHODS National, online cross-sectional surveys of Australian GBM were conducted in 2011, 2013 and 2015. Scales measuring support for and willingness to have sex with men using PrEP were developed in 2015 using factor analysis. Trends and associations with key measures were analysed using multivariate logistic regression. RESULTS During 2011-2015, 3850 surveys were completed by GBM. Willingness to use PrEP among HIV-negative and untested men did not change between 2011 (28.2%) and 2015 (31.7%, p=0.13). In 2015, willingness to use PrEP was independently associated with younger age, having an HIV-positive regular partner, recent condomless anal intercourse with casual male partners (CAIC), more than 10 male sex partners in the previous 6 months, ever having taken postexposure prophylaxis and having fewer concerns about using PrEP. In 2015, 54.5% of GBM supported other GBM taking PrEP and 39% were willing to have sex with men using PrEP. Support for and willingness to have sex with PrEP users were both associated with being HIV-positive, having a university degree and having two or more male partners in the previous 6 months. Willingness to have sex with men on PrEP was also associated with recent CAIC and using party drugs for sex, but was less likely among men who consistently used or had a positive experience using condoms. DISCUSSION Interest in and support for using PrEP are concentrated among men who engage in higher risk practices and who know more about living with HIV. This is consistent with the targeting of PrEP in Australia.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Heather-Marie Schmidt
- Centre for Population Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | | | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Dean Murphy
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia.,The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Hong-Ha Truong
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
| | - John de Wit
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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28
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Hammoud MA, Jin F, Degenhardt L, Lea T, Maher L, Grierson J, Mackie B, Pastorelli M, Batrouney C, Bath N, Bradley J, Prestage GP. Following Lives Undergoing Change (Flux) study: Implementation and baseline prevalence of drug use in an online cohort study of gay and bisexual men in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 41:41-50. [PMID: 28081482 DOI: 10.1016/j.drugpo.2016.11.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal methamphetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM). OBJECTIVE This paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this sample. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen. METHODS Men living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol. RESULTS Between September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs. CONCLUSION Ease of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM.
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Affiliation(s)
- Mohamed A Hammoud
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia.
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Kensington, NSW 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Australia, Kensington, NSW 2052, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Jeffrey Grierson
- Anglia Ruskin University, Cambridge Campus, Cambridge CB1 1PT, United Kingdom
| | - Brent Mackie
- ACON NSW, 414 Elizabeth St, Surry Hills, NSW 2010, Australia
| | | | - Colin Batrouney
- Victorian AIDS Council, 6 Claremont St, South Yarra, VIC 3141, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, 5, 414 Elizabeth St, Surry Hills, NSW 2010, Australia
| | - Jack Bradley
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Garrett P Prestage
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
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Increasing Belief in the Effectiveness of HIV Treatment as Prevention: Results of Repeated, National Surveys of Australian Gay and Bisexual Men, 2013-15. AIDS Behav 2016; 20:1564-71. [PMID: 26803613 DOI: 10.1007/s10461-016-1306-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We surveyed Australian gay and bisexual men, assessing belief in HIV treatment as prevention (TasP) and support for early treatment. We identified the characteristics of participants who believed in TasP and supported early treatment using multivariate logistic regression. In 2013, 1316 men participated; 1251 participated in 2015. Belief in TasP increased from 2.6 % in 2013 to 13.1 % in 2015 (p < 0.001). The increase was most noticeable among HIV-positive men (from 9.7 % to 46.2 %). Support for early treatment increased from 71.8 % to 75.3 % (p = 0.02). Belief in TasP was associated with being HIV-positive, having a tertiary education, having recent condomless anal intercourse with casual male partners, and ever having taken post-exposure prophylaxis. Support for early HIV treatment was associated with being younger, living in New South Wales and being in paid employment. We recommend continued monitoring of the growing gap in belief about TasP between HIV-positive men and HIV-negative/untested men.
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Lee E, Murphy D, Mao L, de Wit J, Prestage G, Zablotska I, Holt M. Social and Behavioural Correlates of HIV Testing Among Australian Gay and Bisexual Men in Regular Relationships. AIDS Behav 2016; 20:1295-301. [PMID: 26324077 DOI: 10.1007/s10461-015-1167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this study we sought to identify the social and behavioural characteristics of Australian gay and bisexual men who had and had not tested for HIV during their current relationship. The results were based on 2012 and 2013 data collected from ongoing cross-sectional and community-based surveys held in six Australian states and territories. One thousand five hundred and sixty-one non-HIV-positive men reported that they were in a primary relationship. The majority of gay and bisexual men in primary relationships had tested for HIV during the relationship (73.4 %). Among men who had not tested during the relationship, almost half of these men had never tested for HIV. As untested men within relationships are potentially at risk of acquiring and transmitting HIV to their partners unknowingly, it is important to promote HIV testing to these men.
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Affiliation(s)
- Evelyn Lee
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia.
| | - Dean Murphy
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
- National Drug Research Institute, Curtin University, Melbourne, 3065, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, Wallace Wurth Building, UNSW, Kensington, NSW, 2033, Australia
| | - Iryna Zablotska
- The Kirby Institute, Wallace Wurth Building, UNSW, Kensington, NSW, 2033, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
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31
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Holt M, Lea T, Kippax S, Kolstee J, Ellard J, Velecky M, Murphy D, de Wit J. Awareness and knowledge of HIV pre-exposure prophylaxis among Australian gay and bisexual men: results of a national, online survey. Sex Health 2016; 13:SH15243. [PMID: 27098165 DOI: 10.1071/sh15243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/06/2016] [Indexed: 11/23/2022]
Abstract
Background: Expanded access to HIV pre-exposure prophylaxis (PrEP) is being actively debated in Australia. Awareness and knowledge of this HIV-prevention method have not been assessed in detail in the primary affected population, gay and bisexual men. Methods: Awareness and knowledge of PrEP were assessed among Australian gay and bisexual men, who were asked to complete a national, anonymous, online survey in 2015. Associations with PrEP awareness were identified with multivariate logistic regression and associations with PrEP knowledge were identified using multivariate linear regression. Results: Among 1251 participants, 954 (77%) were aware of PrEP. The most common sources of information were gay community media, Australian websites and friends. Awareness of PrEP was independently associated with older age, living in a capital city, having a university degree, being tested for HIV, being HIV-positive, having condomless anal intercourse with regular male partners, and ever having taken post-exposure prophylaxis. Men in monogamous relationships were less likely to be aware of PrEP. Among men who were aware of PrEP, the mean PrEP knowledge score was 6.8 out of 13. Relatively few participants knew that taking PrEP involved regular clinical monitoring and that in Australia PrEP was only recommended for people at risk of HIV. Better knowledge was independently associated with living in a capital city, having a university degree, being in full-time employment, being HIV-positive, and ever having taken post-exposure prophylaxis or PrEP. Conclusions: To assist in appropriate PrEP uptake, we recommend educating gay and bisexual men about current Australian prescribing guidelines and how PrEP is accessed in Australia.
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Hull P, Mao L, Prestage G, Zablotska I, de Wit J, Holt M. The use of mobile phone apps by Australian gay and bisexual men to meet sex partners: an analysis of sex-seeking repertoires and risks for HIV and STIs using behavioural surveillance data. Sex Transm Infect 2016; 92:502-507. [PMID: 27095378 DOI: 10.1136/sextrans-2015-052325] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/14/2016] [Accepted: 04/01/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Mobile phone apps are now the most popular method that Australian gay men use to find sex partners. Partner-seeking mobile phone apps use location functions to identify like-minded men and display their proximity. This study examines whether meeting partners via mobile apps is associated with a greater risk of HIV and sexually transmitted infections (STIs) than with other ways of meeting partners. METHODS Data were analysed from the Gay Community Periodic Surveys, community-based, cross-sectional surveys conducted in Australian state capital cities between 2010 and 2014. χ2 tests and multinomial logistic regression were used to analyse differences in risk profiles of men who used different methods to meet partners. RESULTS Data were analysed from 36 428 men who participated in the Gay Community Periodic Surveys between 2010 and 2014. In 2014, 4116 men reported meeting sex partners with the use of mobile apps, increasing from 23.9% in 2011 to 42.5% in 2014. Men who used a combination of online and offline methods reported a greater number of sex partners and were more likely to report a recent STI than men who used online methods only or offline methods only. CONCLUSIONS There has been a steep increase in the use of mobile phone apps by gay men in Australia to meet male partners. However, men who use a combination of mobile phone apps, internet websites and offline places to meet partners appear to be at increased risk of STIs or HIV compared with men who use a narrower range of online and offline methods.
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Affiliation(s)
- Peter Hull
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | | | | | - John de Wit
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, Australia
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Methamphetamine use among gay and bisexual men in Australia: Trends in recent and regular use from the Gay Community Periodic Surveys. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 29:66-72. [DOI: 10.1016/j.drugpo.2016.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/09/2015] [Accepted: 01/06/2016] [Indexed: 12/22/2022]
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Brief Report: HIV Prevention by Australian Gay and Bisexual Men With Casual Partners: The Emergence of Undetectable Viral Load as One of a Range of Risk Reduction Strategies. J Acquir Immune Defic Syndr 2016; 70:545-8. [PMID: 26258572 DOI: 10.1097/qai.0000000000000787] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We analyzed the HIV risk reduction strategies (RRS) used by Australian gay and bisexual men with casual partners. Among 1346 men who reported any condomless anal intercourse with casual partners, 75% frequently practiced at least one RRS. The most common RRS was serosorting, frequently practiced by 55% of HIV-positive and 47% of HIV-negative participants. Condoms were frequently (but inconsistently) used by 17% of HIV-positive, 41% of HIV-negative, and 30% of untested participants. Relying on an undetectable viral load was frequently practiced by 58% of HIV-positive participants. Strategic positioning, withdrawal, and non-HIV-positive men taking antiretroviral medication were less common strategies.
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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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Moore CL, Grulich AE, Prestage G, Gidding HF, Jin F, Mao L, Petoumenos K, Zablotska IB, Poynten IM, Law MG, Amin J. Hospitalisation rates and associated factors in community-based cohorts of HIV-infected and -uninfected gay and bisexual men. HIV Med 2015; 17:327-39. [PMID: 26344061 DOI: 10.1111/hiv.12312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES There is evidence that HIV-positive patients are suffering from a greater burden of morbidity as they age due to nonAIDS-related complications. To date it has been difficult to determine what part of this excess risk is due to the health effects of HIV, its treatment or to lifestyle factors common to gay and bisexual men (GBM). We calculated overall and cause-specific hospitalisation rates and risk factors for hospitalisations in HIV-negative and HIV-positive cohorts of GBM and compare these with rates in the general male population. METHODS We conducted a record linkage study, linking two cohorts of HIV-negative (n = 1325) and HIV-positive (n = 557) GBM recruited in Sydney, New South Wales (NSW), Australia with the NSW hospital discharge data register. We compared rates of hospitalisation in the two cohorts and risk factors for hospitalisation using random-effects Poisson regression methods. Hospitalisation rates for each cohort were further compared with those in the general male population using indirect standardisation. RESULTS We observed 2032 hospitalisations in the HIV-negative cohort during 13,016 person-years (PYs) [crude rate: 15.6/100 PYs (95% CI: 14.9-16.3)] and 2130 hospitalisations in the HIV-positive cohort during 5571 PYs [crude rate: 38.2/100 PYs (95% CI: 36.6-39.9)]. HIV-positive individuals had an increased risk of hospitalisation compared with the HIV-negative individuals [adjusted-IRR: 2.34 (95% CI: 1.91-2.86)] and the general population [SHR: 1.45 (95% CI: 1.33-1.59)]. Hospitalisation rates were lower in the HIV-negative cohort compared with the general population [SHR: 0.72 (95% CI: 0.67-0.78)]. The primary causes of hospitalisation differed between groups. CONCLUSIONS HIV-positive GBM continue to experience excess morbidity compared with HIV-negative GBM men and the general population. HIV-negative GBM had lower morbidity compared with the general male population suggesting that GBM identity does not confer excess risk.
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Affiliation(s)
- C L Moore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - A E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - G Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
| | - H F Gidding
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - F Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - L Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - K Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - I B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - I M Poynten
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M G Law
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - J Amin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney. J Int AIDS Soc 2015; 18:20221. [PMID: 26318960 PMCID: PMC4552862 DOI: 10.7448/ias.18.1.20221] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/29/2015] [Accepted: 08/12/2015] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION HIV diagnoses among gay and bisexual men have increased over the past decade in Australia. HIV point-of-care testing (POCT) was introduced in Australia in 2011 as a strategy to increase HIV testing by making the testing process more convenient. We surveyed gay and bisexual men undergoing POCT to assess barriers to HIV testing and characteristics associated with not having previously tested for HIV (never testing). METHODS During 2011 and 2012, gay and bisexual men who were undergoing POCT at four Sydney sexual health clinics self-completed questionnaires assessing testing history and psychological and structural barriers to HIV testing. Bivariate and multivariate logistic regression was used to assess associations between patient characteristics and never testing. RESULTS Of 1093 participants, 981 (89.9%) reported ever testing for HIV and 110 (10.1%) never testing. At least one barrier to testing was reported by 1046 men (95.7%), with only 47 men (4.3%) not reporting any barrier to testing. The most commonly reported barriers to testing were annoyance at having to return for results (30.2%), not having done anything risky (29.6%), stress in waiting for results (28.4%), being afraid of testing positive (27.5%) and having tested recently (23.2%). Never testing was independently associated with being non-gay-identified (adjusted odds ratio [AOR]: 1.9; 95% confidence interval [CI]: 1.1-3.2), being aged less than 25 years (AOR: 2.4; 95% CI: 1.6-3.8), living in a suburb with few gay couples (AOR: 1.9; 95% CI: 1.2-3.0), being afraid of testing HIV-positive (AOR: 1.6; 95% CI: 1.0-2.4), not knowing where to test (AOR: 3.8; 95% CI: 1.3-11.2) and reporting one or no sexual partners in the last six months (AOR: 2.7; 95% CI: 1.2-6.2). CONCLUSIONS Barriers to HIV testing were commonly reported among the clinic-based gay and bisexual men in this study. Our findings suggest further health promotion and prevention strategies are needed to address the knowledge, attitudes and behavioural factors associated with never testing.
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Poynten IM, Machalek D, Templeton D, Jin F, Hillman R, Zablotzska I, Prestage G, Holt M, Grulich A. Comparison of age-specific patterns of sexual behaviour and anal HPV prevalence in homosexual men with patterns in women. Sex Transm Infect 2015; 92:228-31. [PMID: 26306829 DOI: 10.1136/sextrans-2015-052032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 08/04/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Anal human papillomavirus (HPV) is highly prevalent in men who have sex with men (MSM) of all ages, whereas cervical HPV declines with age. We explore the hypothesis that different sexual behavioural patterns are the basis of this difference in age distribution. METHODS Published data on age-specific HPV prevalence for women (cervical HPV) were extracted from a large meta-analysis and for MSM (anal HPV) from the EXPLORE study of HIV-negative MSM. Age-specific data on recent sexual activity were extracted from two behavioural surveys: the second Australian Study of Health and Relationships survey and the 2013 Gay Community Periodic Survey. RESULTS At least 50% of MSM at all ages reported more than one sexual partner in the past 6 months. In comparison, 33% of women aged 16-19 years reported more than one partner over the past year. This decreased to 19% and 6% in women aged 20-29 and 30-39 years, respectively, and to fewer than 5% of women in older age groups. Prevalent anal HPV was detected in over 50% of MSM in each age group. Prevalence did not decline with age. In contrast, there was a steady decrease in cervical HPV prevalence with age. Cervical HPV prevalence fell from 23% among North American women aged <25 years to 3% in women aged ≥65 years. CONCLUSIONS In contrast to the decreasing prevalence with age among heterosexual women, the high prevalence and lack of decline in prevalent anal HPV among older MSM are likely to be related to continuing high rates of newly acquired HPV infection from ongoing sexual exposure through new partners.
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Affiliation(s)
| | - Dorothy Machalek
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - David Templeton
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia Royal Prince Alfred Hospital Sexual Health, Sydney, New South Wales, Australia
| | - Fengyi Jin
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Richard Hillman
- Western Sydney Sexual Health Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Iryna Zablotzska
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Garrett Prestage
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Andrew Grulich
- Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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Ward J, Bryant J, Wand H, Kaldor J, Delaney-Thiele D, Worth H, Betts S, Waples-Crowe P, Cairnduff S, Coburn T, Donovan B, Pitts M. Methods of a national survey of young Aboriginal and Torres Strait Islander people regarding sexually transmissible infections and bloodborne viruses. Aust N Z J Public Health 2015; 40 Suppl 1:S96-101. [PMID: 26259735 DOI: 10.1111/1753-6405.12427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/01/2015] [Accepted: 04/01/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe the methods and basic demographics of participants in a national survey of Aboriginal and Torres Strait Islander (Aboriginal) people specific to sexually transmissible infections and bloodborne viruses. METHODS A national cross-sectional survey of Aboriginal people aged 16-29 years in all Australian jurisdictions between 2011 and 2013 conducted at Aboriginal community events. Questions comprised demographic information, knowledge, risk behaviours and health service utilisation. Questionnaires were completed on personal digital assistants (PDAs). RESULTS A total of 2,877 people at 21 unique community events completed the questionnaire. A total of 59% of participants were female, median age was 21 years and more than 60% were single at the time of the survey. Just over half the participants were resident in an urban area (53%) and 38% were from a regional area. Aboriginal health organisations played an important role in implementing the research. PDAs were found to be an acceptable method for collecting health information. CONCLUSION This survey has recruited a large representative sample of Aboriginal people aged 16-29 years using a methodology that is feasible, acceptable and repeatable. IMPLICATIONS The methodology provides a model for ongoing monitoring of this population as programs and policies are implemented to address young Aboriginal people's STI and BBV risks.
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Affiliation(s)
- James Ward
- South Australian Health and Medical Research Institute
| | - Joanne Bryant
- Centre for Social Health Research, University of New South Wales
| | - Handan Wand
- Kirby Institute, University of New South Wales
| | - John Kaldor
- Kirby Institute, University of New South Wales
| | | | - Heather Worth
- School of Public Health and Community Medicine, University of New South Wales
| | - Sarah Betts
- Aboriginal Health Council of South Australia
| | | | - Sallie Cairnduff
- Aboriginal Health and Medical Research Council of New South Wales
| | - Tony Coburn
- Queensland Aboriginal and Islander Health Council
| | - Basil Donovan
- Kirby Institute, University of New South Wales
- Sydney Sexual Health Centre, Sydney Hospital, New South Wales
| | - Marian Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria
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Jin F, Prestage GP, Mao L, Poynten IM, Templeton DJ, Grulich AE, Zablotska I. "Any Condomless Anal Intercourse" is No Longer an Accurate Measure of HIV Sexual risk Behavior in Gay and Other Men Who have Sex with Men. Front Immunol 2015; 6:86. [PMID: 25774158 PMCID: PMC4343002 DOI: 10.3389/fimmu.2015.00086] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM). A variety of measures of CLAI have been commonly used in behavioral surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM's sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as "any CLAI" do not accurately measure HIV sexual risk behavior. METHODS Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last 6 months were collected, separated by partner type (regular vs. casual) and partners' HIV status (negative, positive, and HIV status unknown). RESULTS A total of 228,064 episodes of CLAI were reported during the study period with a mean of 44 episodes per year per participant (median: 14). The great majority of CLAI episodes were with a regular partner (92.6%), most of them with HIV-negative regular partners (84.8%). Participants were more likely to engage in insertive CLAI with casual than with regular partners (66.7 vs. 55.3% of all acts of CLAI with each partner type, p < 0.001). Men were more likely to report CLAI in the receptive position with HIV-negative and HIV status unknown partners than with HIV-positive partners (p < 0.001 for both regular and casual partners). CONCLUSION Gay and other MSM engaging in CLAI demonstrate clear patterns of HIV risk reduction behavior. As HIV prevention enters the era of antiretroviral-based biomedical approach, using all forms of CLAI indiscriminately as a measure of HIV behavioral risk is not helpful in understanding the current drivers of HIV transmission in the community.
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Affiliation(s)
- Fengyi Jin
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Garrett P. Prestage
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Limin Mao
- The Centre for Social Research in Health, University of New South Wales, Kensington, NSW, Australia
| | - I. Mary Poynten
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - David J. Templeton
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
- RPA Sexual Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Andrew E. Grulich
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Iryna Zablotska
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
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Willingness to use HIV pre-exposure prophylaxis has declined among australian gay and bisexual men: results from repeated national surveys, 2011-2013. J Acquir Immune Defic Syndr 2015; 67:222-6. [PMID: 25078535 DOI: 10.1097/qai.0000000000000287] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We surveyed willingness to use pre-exposure prophylaxis (PrEP) and the likelihood of decreased condom use among Australian gay and bisexual men in 2011 and 2013 (n = 2384). Willingness to use PrEP declined from 28.2% to 23.3% [adjusted odds ratio = 0.83, 95% confidence interval (CI): 0.68 to 1.00, P = 0.050]. Willingness to use PrEP was the greatest among men with HIV-positive partners and among those who had taken HIV postexposure prophylaxis. Among men willing to use PrEP, the likelihood of decreased condom use remained stable between 2011 and 2013 (8.0% vs. 11.9%; adjusted odds ratio = 1.40, 95% CI: 0.80 to 2.45, P = 0.23). A minority of men remain willing to use PrEP and appear to be appropriate candidates for it.
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De La Mata NL, Mao L, De Wit J, Smith D, Holt M, Prestage G, Wilson DP, Petoumenos K. Estimating antiretroviral treatment coverage rates and viral suppression rates for homosexual men in Australia. Sex Health 2015; 12:453-7. [PMID: 26166247 DOI: 10.1071/sh15037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/24/2015] [Indexed: 11/23/2022]
Abstract
Gay and other men who have sex with men (GMSM) are disproportionally affected by the HIV epidemic in Australia. The study objective is to combine a clinical-based cohort with a community-based surveillance system to present a broader representation of the GMSM community to determine estimates of proportions receiving antiretroviral therapy (ART) and/or with an undetectable viral load. Between 2010 and 2012, small increases were shown in ART uptake (to 70.2%) and proportions with undetectable viral load (to 62.4%). The study findings highlight the potential for significantly increasing ART uptake among HIV-positive GMSM to reduce the HIV epidemic in Australia.
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Affiliation(s)
- Nicole L De La Mata
- Kirby Institute, Wallace Wurth Building, UNSW Australia, UNSW Sydney, NSW 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, Goodsell Building, UNSW Australia, UNSW Sydney, NSW 2052, Australia
| | - John De Wit
- Centre for Social Research in Health, Goodsell Building, UNSW Australia, UNSW Sydney, NSW 2052, Australia
| | - Don Smith
- Albion Street Centre, Albion Street, Surry Hills, NSW 2010, Australia
| | - Martin Holt
- Centre for Social Research in Health, Goodsell Building, UNSW Australia, UNSW Sydney, NSW 2052, Australia
| | - Garrett Prestage
- Kirby Institute, Wallace Wurth Building, UNSW Australia, UNSW Sydney, NSW 2052, Australia
| | - David P Wilson
- Kirby Institute, Wallace Wurth Building, UNSW Australia, UNSW Sydney, NSW 2052, Australia
| | - Kathy Petoumenos
- Kirby Institute, Wallace Wurth Building, UNSW Australia, UNSW Sydney, NSW 2052, Australia
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Santella AJ, Schlub TE, Ooi C, Varma R, Holt M, Prestage G, Hillman RJ. Sexual behaviour and HIV prevention needs of men attending a suburban Sex on Premises Venue. Sex Health 2015; 12:383-9. [DOI: 10.1071/sh14227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 05/21/2015] [Indexed: 11/23/2022]
Abstract
Background
Sexual behaviour and HIV prevention needs of men who have sex with men (MSM) attending suburban Sex on Premises Venues (SOPVs) are understudied. Methods: A cross-sectional survey examining sexual activity, health services utilisation, sexual health services needs and STI knowledge was conducted among MSM over 18 years old attending a SOPV in Western Sydney between June and July 2013. Results: A total of 213 MSM were sampled; approximately half of the respondents (51%) reported that they only had sex with other men, and 46% had sex with both men and women. Condom use varied considerably, with ~50% of responders not using condoms consistently during anal sex. Consistent condom usage was not associated with having regular, casual or a mix of regular and casual partners during anal sex (P = 0.09). The majority (59.5%) obtained sexual health screening services from general practitioners; only 15.0% sought services from a local sexual health clinic. Over half of respondents (57.7%) believed that SOPVs should offer on-site and free testing services. Those with the highest level of previous STI diagnoses were gay men (41%), those who only had casual partners (38%) and those who did not complete high school (65%). Conclusions: Sexual health services and non-government organisations should consider targeting bisexual men with rapid HIV testing and condom usage campaigns. Low cost or free on-site HIV and STI testing at SOPVs and stronger partnerships between general practitioners and sexual health services are needed.
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Lea T, Ryan D, Prestage G, Zablotska I, Mao L, de Wit J, Holt M. Alcohol use among a community-based sample of gay men: Correlates of high-risk use and implications for service provision. Drug Alcohol Rev 2014; 34:349-57. [PMID: 25546071 DOI: 10.1111/dar.12234] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/23/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS International research has shown that gay, bisexual and other homosexually active men (hereafter 'gay men') report disproportionately higher rates of risky alcohol use and associated problems compared with heterosexual men. However, little is known about alcohol use among this population in Australia. This study aimed to examine rates of risky alcohol use among a community-based sample of gay men in Sydney and characteristics of men reporting high-risk alcohol use and adverse consequences. DESIGN AND METHODS A cross-sectional survey of gay men was conducted in Sydney in August 2013 as part of the ongoing Gay Community Periodic Surveys (n = 1546 eligible respondents). The Alcohol Use Disorders Identification Test-Consumption questions were used to assess alcohol use in the previous 12 months. RESULTS Nine percent of respondents were categorised as abstinent from alcohol, 33% as low-risk drinkers, 42% as moderate-risk drinkers and 16% as high-risk drinkers. In separate multivariate logistic regression analyses, high-risk drinking and reporting ≥4 adverse alcohol consequences were associated with younger age, being Australian-born, recruitment from licensed premises and having met men for sex at gay bars and dance parties. Fifty-eight percent of high-risk drinkers reported a desire to reduce their alcohol use. DISCUSSION AND CONCLUSIONS In this community-based sample of gay men, we found high levels of moderate- to high-risk alcohol use. The results suggest that gay men should be a priority population for health promotion campaigns and treatment services.
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Affiliation(s)
- Toby Lea
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | | | - Garrett Prestage
- The Kirby Institute, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Iryna Zablotska
- The Kirby Institute, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia
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Zablotska IB, Frankland A, Holt M, de Wit J, Brown G, Maycock B, Fairley C, Prestage G. Methodological challenges in collecting social and behavioural data regarding the HIV epidemic among gay and other men who have sex with men in Australia. PLoS One 2014; 9:e113167. [PMID: 25409440 PMCID: PMC4237373 DOI: 10.1371/journal.pone.0113167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/20/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Behavioural surveillance and research among gay and other men who have sex with men (GMSM) commonly relies on non-random recruitment approaches. Methodological challenges limit their ability to accurately represent the population of adult GMSM. We compared the social and behavioural profiles of GMSM recruited via venue-based, online, and respondent-driven sampling (RDS) and discussed their utility for behavioural surveillance. METHODS Data from four studies were selected to reflect each recruitment method. We compared demographic characteristics and the prevalence of key indicators including sexual and HIV testing practices obtained from samples recruited through different methods, and population estimates from respondent-driven sampling partition analysis. RESULTS Overall, the socio-demographic profile of GMSM was similar across samples, with some differences observed in age and sexual identification. Men recruited through time-location sampling appeared more connected to the gay community, reported a greater number of sexual partners, but engaged in less unprotected anal intercourse with regular (UAIR) or casual partners (UAIC). The RDS sample overestimated the proportion of HIV-positive men and appeared to recruit men with an overall higher number of sexual partners. A single-website survey recruited a sample with characteristics which differed considerably from the population estimates with regards to age, ethnically diversity and behaviour. Data acquired through time-location sampling underestimated the rates of UAIR and UAIC, while RDS and online sampling both generated samples that underestimated UAIR. Simulated composite samples combining recruits from time-location and multi-website online sampling may produce characteristics more consistent with the population estimates, particularly with regards to sexual practices. CONCLUSION Respondent-driven sampling produced the sample that was most consistent to population estimates, but this methodology is complex and logistically demanding. Time-location and online recruitment are more cost-effective and easier to implement; using these approaches in combination may offer the potential to recruit a more representative sample of GMSM.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, The University of NSW Australia, Sydney, NSW, Australia
| | - Andrew Frankland
- The Kirby Institute, The University of NSW Australia, Sydney, NSW, Australia; School of Psychiatry, The University of NSW Australia, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, The University of NSW Australia, Sydney, NSW, Australia
| | - John de Wit
- Centre for Social Research in Health, The University of NSW Australia, Sydney, NSW, Australia
| | - Graham Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia; Curtin University, Perth, WA, Australia
| | | | - Christopher Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | - Garrett Prestage
- The Kirby Institute, The University of NSW Australia, Sydney, NSW, Australia; The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
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Australian gay and bisexual men's attitudes to HIV treatment as prevention in repeated, national surveys, 2011-2013. PLoS One 2014; 9:e112349. [PMID: 25386943 PMCID: PMC4227707 DOI: 10.1371/journal.pone.0112349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/13/2014] [Indexed: 11/29/2022] Open
Abstract
Objective Assess the acceptability of HIV treatment as prevention and early antiretroviral treatment among gay and bisexual men in Australia and any changes in attitudes over time. Methods National, online, cross-sectional surveys of gay and bisexual men were repeated in 2011 and 2013. Changes in attitudes to HIV treatment over time were assessed with multivariate analysis of variance. The characteristics of men who agreed that HIV treatment prevented transmission and thought that early treatment was necessary were identified with multivariate logistic regression. Results In total, 2599 HIV-negative, untested and HIV-positive men participated (n = 1283 in 2011 and n = 1316 in 2013). Attitudes changed little between 2011 and 2013; most participants remained sceptical about the preventative benefits of HIV treatment. In 2013, only 2.6% of men agreed that HIV treatment prevented transmission; agreement was associated with being HIV-positive, having an HIV-positive regular partner, and having received HIV post-exposure prophylaxis. In contrast, 71.8% agreed that early antiretroviral treatment is necessary; younger men were more likely and HIV-positive men and participants with HIV-positive partners were much less likely to agree with this. Conclusions Promoting the individual health benefits of HIV treatment rather than its preventative benefits remains more acceptable to Australian gay and bisexual men.
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Zablotska IB, Holt M, de Wit J, Mao L, Down I, Prestage G. At home and away: gay men and high risk sexual practices. AIDS Behav 2014; 18:1436-42. [PMID: 24158485 DOI: 10.1007/s10461-013-0635-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We aimed to describe HIV risk practices of gay men who travel locally, regionally and overseas. We analysed data from the Sydney Gay Community Periodic Survey 2009 about high-risk sexual practices in four locations (locally, while travelling in NSW, Australia and overseas) and with partners of HIV positive, negative and unknown serostatus in each location. Analyses of associations used generalized log-binomial estimation procedures with Type I error of 5 %. Of 1,839 sexually active participants, 70.1 % reported having sex locally. 19.7 % elsewhere in NSW, 20.1 % interstate and 18 % overseas. Unprotected anal intercourse (UAI) was reported by 29.9, 28.6, 21.3 and 19.3 % of men in each location respectively. There was no difference in the levels of UAI locally and elsewhere in NSW, but UAI levels were lower in other Australian locations [adjusted prevalence rate ratio (APRR) = 0.76; 95 % confidence interval (95 % CI) 0.66-0.88] and overseas (APRR = 0.76; 95 % CI 0.65-0.89). UAI was more likely if partners were seroconcordant HIV positive (APRR = 1.67; 95 % CI 1.32-2.11) and less likely if partners were of different HIV serostatus (APRR = 0.39; 95 % CI 0.33-0.47) as compared to seroconcordant HIV negative partners. UAI was associated with group sex and use of party drugs. In this community sample, UAI levels were higher in the local context than in travel destinations, suggesting that familiarity between partners may play a role. High-risk sexual practices can nevertheless contribute to bridging different HIV epidemics and HIV transmission across borders. HIV prevention programs should develop effective approaches to target sexually adventurous gay men and HIV transmission associated with travel.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia,
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Mao L, de Wit JB, Kippax SC, Prestage G, Holt M. Younger age, recent HIV diagnosis, no welfare support and no annual sexually transmissible infection screening are associated with nonuse of antiretroviral therapy among HIV-positive gay men in Australia. HIV Med 2014; 16:32-7. [PMID: 24889053 DOI: 10.1111/hiv.12169] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES With the increasing momentum to maximize the benefits of antiretroviral therapy (ART), better understanding of opportunities and challenges in increasing ART coverage and promoting early ART initiation is urgently needed. Key sociodemographic, clinical and behavioural factors associated with Australian HIV-positive gay men's current nonuse of ART were systematically examined. METHODS Data were based on 1911 responses from HIV-positive men who had participated in the Australian Gay Community Periodic Surveys (GCPS) between 2010 and 2012. Stratified univariate analysis and multivariate logistic regression were used. RESULTS A majority of the participants were recruited from gay community venues and events and self-identified as gay or homosexual. On average, they were 44 years old and had been living with HIV for at least 10 years. Close to 80% (n=1555) were taking ART, with >90% further reporting an undetectable viral load at the time of the survey. From 2010 to 2012, there had been a moderate increase in ART uptake [adjusted odds ratio (AOR) 1.40; 95% confidence interval (CI) 1.20-1.65]. In addition, younger age (AOR 1.66; 95% CI 1.45-1.92), recent HIV diagnosis (AOR 1.78; 95% CI 1.59-1.98), not receiving any social welfare payments (AOR 2.20; 95% CI 1.05-2.54) and no annual screening for sexually transmissible infections (AOR 1.55; 95% CI 1.03-2.34) were independently associated with ART nonuse. CONCLUSIONS Current ART coverage among HIV-positive gay men in Australia is reasonably high. To further increase ART coverage and promote early ART initiation in this population, better clinical care and sustained structural support are needed for HIV management throughout their life course.
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Affiliation(s)
- L Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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Lea T, Lee E, Mao L, de Wit J, Holt M. HIV and hepatitis C virus co-infection among men who have sex with men in Sydney, and associations with sexual and drug use practices. Sex Health 2014; 10:448-51. [PMID: 23849088 DOI: 10.1071/sh13042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/14/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years there has been an increase in the incidence of acute hepatitis C virus (HCV) in men who have sex with men (MSM). The aim of the present study was to examine the prevalence of HIV/HCV co-infection among MSM in Sydney, and to compare sexual and drug use risk practices of HIV/HCV co-infected MSM with HIV and HCV mono-infected MSM. METHODS Data were collected from gay and other homosexually active men as part of the ongoing Gay Community Periodic Surveys (GCPS). The analysis herein presents findings from the Sydney GCPS in August 2011, which collected data on HCV for the first time. The survey was completed by 2009 respondents. RESULTS Three per cent of respondents self-reported being HCV positive (representing 9.0% of HIV-positive men and 1.9% of HIV-negative men). Overall, 1.2% of respondents reported being HIV/HCV co-infected. HIV/HCV co-infected men were more likely than HCV or HIV mono-infected men to report several sexual and drug use practices that may increase the risk of blood-borne virus transmission. CONCLUSIONS Consistent with other research, we found a higher prevalence of HCV among HIV-positive than HIV-negative men. Several risk practices were more commonly reported among HIV/HCV co-infected men. These findings, and the increasing incidence of HCV in MSM, reinforce the need for routine HCV screening in this population.
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Affiliation(s)
- Toby Lea
- Centre for Social Research in Health, (Formerly National Centre in HIV Social Research), John Goodsell Building, University of New South Wales, Sydney, NSW 2052, Australia
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Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11:217-29. [DOI: 10.1071/sh14003] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/09/2014] [Indexed: 01/07/2023]
Abstract
Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009–May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.
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