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Dowell-Day A, Dobbins T, Chan C, Fraser D, Holt M, Vaccher SJ, Clifton B, Zablotska I, Grulich A, Bavinton BR. Attitudes Towards Treatment as Prevention Among PrEP-Experienced Gay and Bisexual Men in Australia. AIDS Behav 2023:10.1007/s10461-023-04019-x. [PMID: 36877254 PMCID: PMC10386911 DOI: 10.1007/s10461-023-04019-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/07/2023]
Abstract
The introduction of HIV pre-exposure prophylaxis (PrEP) has the potential to impact the attitudes gay and bisexual men (GBM) who consequently choose to take PrEP have towards treatment as prevention (TasP), and the extent to which they are willing to have condomless anal intercourse (CLAI) with an HIV-positive sexual partner who has an undetectable viral load (UVL). Using a cross-sectional sample from an observational cohort study conducted from August 2018 to March 2020, we examined the extent to which PrEP-experienced GBM are willing to have CLAI with a partner who has a UVL. Simple and multiple logistic regression models were used to identify associated variables. Of the 1386 participants included in the analyses, 79.0% believed in the effectiveness of TasP, and 55.3% were willing to have CLAI with a partner who has a UVL. Wiling participants were less worried about getting HIV when taking PrEP and more likely to believe in TasP. Further research is needed to better understand the gap between belief in TasP and willingness to have CLAI with a partner who has a UVL among PrEP-experienced GBM.
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Affiliation(s)
- Alexander Dowell-Day
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy Dobbins
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Brent Clifton
- National Association of People with HIV Australia, Newtown, NSW, Australia
| | - Iryna Zablotska
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia.,Sydney Infectious Diseases Institute, University of Sydney, Westmead, Australia.,Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia
| | - Andrew Grulich
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Keen P, Jamil M, Callander D, Conway DP, McNulty A, Davies SC, Couldwell DL, Smith DE, Holt M, Vaccher SJ, Gray J, Cunningham P, Prestage G, Guy R. Rapid HIV testing increases testing frequency among gay and bisexual men: a controlled before-after study. Sex Health 2020; 16:172-179. [PMID: 30944062 DOI: 10.1071/sh18161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
Background Rapid HIV testing was introduced at 12 clinics in New South Wales (NSW) for routine testing and promoted with social marketing. The effect of the availability of rapid HIV testing on testing frequency among gay and bisexual men (GBM) was evaluated. METHODS An observational design using patient data from 12 clinics was used. The primary outcome was the mean number of HIV tests in 12 months. The intervention group comprised GBM who had one or more rapid tests from October 2013 to September 2014 and this was compared with two control groups; a concurrent group (no rapid test in the same period) and a historical group (attended between July 2011 and June 2012). Independent sample t-tests were conducted to compare mean number of tests among men in the intervention, concurrent and historical groups. Multivariate logistic regression was used to assess the association between rapid HIV testing and testing frequency. RESULTS Men in the intervention group (n = 3934) had a mean of 1.8 HIV tests in 12 months, compared with 1.4 in the concurrent group (n = 5063; P < 0.001) and 1.4 in the historical group (n = 5904; P < 0.001); testing frequency was higher among men at increased risk of HIV in the intervention group compared with the other two groups (mean 2.2, 1.6 and 1.5 respectively; P < 0.001). Membership of the intervention group was associated with increased odds of having two or more HIV tests in 12 months (AOR = 2.5, 95%CI 2.2-2.8; P < 0.001) compared with the concurrent group, after controlling for demographic and behavioural factors. CONCLUSION Introducing and promoting rapid HIV testing in clinics in NSW was associated with increased HIV testing frequency among GBM.
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Affiliation(s)
- Phillip Keen
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia; and Corresponding author.
| | - Muhammad Jamil
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | | | - Damian P Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia; and School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Stephen C Davies
- North Shore Sexual Health Service, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; and Sydney Medical School, University of Sydney, NSW 2006, Australia
| | - Deborah L Couldwell
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, NSW 2150, Australia; and The Marie Bashir Institute for Infectious Diseases, University of Sydney, NSW 2145, Australia
| | - Don E Smith
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW 2052, Australia; and Albion Centre, 150 Albion Street, Surry Hills, NSW 2010, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | | | - James Gray
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia; and ACON, 414 Elizabeth Street, Surry Hills, Sydney, NSW 2010, Australia
| | - Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia; and St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
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Vaccher SJ, Hammoud MA, Bourne A, Lea T, Haire BG, Holt M, Saxton P, Mackie B, Badge J, Jin F, Maher L, Prestage G. Prevalence, frequency, and motivations for alkyl nitrite use among gay, bisexual and other men who have sex with men in Australia. Int J Drug Policy 2020; 76:102659. [PMID: 31927224 DOI: 10.1016/j.drugpo.2019.102659] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/14/2019] [Accepted: 12/29/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration. METHODS Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis. RESULTS Median age was 33 years (IQR 25-46) and 801 GBM (45.9%) had used poppers in the previous six months ('recent use'). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a 'buzz' during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71; 95%CI 1.35-2.16) and chemsex (aOR 4.32; 95%CI 3.15-5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised; 65.0% said they would 'find other ways' to obtain them. CONCLUSIONS Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.
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Affiliation(s)
- Stefanie J Vaccher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Mohamed A Hammoud
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Toby Lea
- German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Konrad-Adenauer-Ufer 79-81, 50668 Cologne, Germany; Centre for Social Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Bridget G Haire
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Peter Saxton
- School of Population Health, University of Auckland, Auckland 1023, New Zealand.
| | - Brent Mackie
- ACON, 414 Elizabeth St, Surry Hills, NSW 2010, Australia.
| | - Joshua Badge
- School of Humanities and Social Sciences, Deakin University, Burwood, Victoria 3125, Australia.
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052, Australia.
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Zablotska IB, Vaccher SJ, Bloch M, Carr A, Foster R, Grulich AE, Guy R, McNulty A, Ooi C, Pell C, Poynten IM, Prestage G, Ryder N, Templeton D. High Adherence to HIV Pre-exposure Prophylaxis and No HIV Seroconversions Despite High Levels of Risk Behaviour and STIs: The Australian Demonstration Study PrELUDE. AIDS Behav 2019; 23:1780-1789. [PMID: 30284653 DOI: 10.1007/s10461-018-2290-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PrELUDE study evaluated daily pre-exposure prophylaxis (PrEP) in high-risk individuals in Australia. This open-label, single-arm study tested participants for HIV/STI and collected behavioural information three-monthly. We report trends over 18 months in medication adherence, side-effects, HIV/STI incidence and behaviour. 320 gay/bisexual men (GBM), 4 women and 3 transgender participants, followed on average 461 days, reported taking seven pills/week on 1,591 (88.5%) occasions and 4-6 pills/week on 153 (8.5%) occasions. No HIV infections were observed. STI incidence was high and stable, while gonorrhoea infections declined from 100.0 to 25.8/100 person-years between 6 and 15 months (p < 0.001). The number of HIV-positive and unknown-status sex partners, and condomless anal intercourse, significantly increased. In this high-risk cohort of mainly GBM, increases in risk behaviours and high STI incidence were not accompanied by HIV infections due to high adherence to daily PrEP. The study informed policy and further PrEP implementation among Australian GBM.
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Vaccher SJ, Kaldor JM, Callander D, Zablotska IB, Haire BG. Qualitative Insights Into Adherence to HIV Pre-Exposure Prophylaxis (PrEP) Among Australian Gay and Bisexual Men. AIDS Patient Care STDS 2018. [DOI: 10.1089/apc.2018.0106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
| | | | - Denton Callander
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Iryna B. Zablotska
- Westmead Clinical School, University of Sydney Medical School, Sydney, Australia
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Vaccher SJ, Gianacas C, Templeton DJ, Poynten IM, Haire BG, Ooi C, Foster R, McNulty A, Grulich AE, Zablotska IB. Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project. Front Public Health 2017; 5:341. [PMID: 29326917 PMCID: PMC5736869 DOI: 10.3389/fpubh.2017.00341] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/30/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction The effectiveness of daily pre-exposure prophylaxis (PrEP) is well established. However, there has been increasing interest in non-daily dosing schedules among gay and bisexual men (GBM). This paper explores preferences for PrEP dosing schedules among GBM at baseline in the PRELUDE demonstration project. Materials and methods Individuals at high-risk of HIV were enrolled in a free PrEP demonstration project in New South Wales, Australia, between November 2014 and April 2016. At baseline, they completed an online survey containing detailed behavioural, demographic, and attitudinal questions, including their ideal way to take PrEP: daily (one pill taken every day), event-driven (pills taken only around specific risk events), or periodic (daily dosing during periods of increased risk). Results Overall, 315 GBM (98% of study sample) provided a preferred PrEP dosing schedule at baseline. One-third of GBM expressed a preference for non-daily PrEP dosing: 20% for event-driven PrEP, and 14% for periodic PrEP. Individuals with a trade/vocational qualification were more likely to prefer periodic to daily PrEP [adjusted odds ratio (aOR) = 4.58, 95% confidence intervals (95% CI): (1.68, 12.49)], compared to individuals whose highest level of education was high school. Having an HIV-positive main regular partner was associated with strong preference for daily, compared to event-driven PrEP [aOR = 0.20, 95% CI: (0.04, 0.87)]. Participants who rated themselves better at taking medications were more likely to prefer daily over periodic PrEP [aOR = 0.39, 95% CI: (0.20, 0.76)]. Discussion Individuals’ preferences for PrEP schedules are associated with demographic and behavioural factors that may impact on their ability to access health services and information about PrEP and patterns of HIV risk. At the time of data collection, there were limited data available about the efficacy of non-daily PrEP schedules, and clinicians only recommended daily PrEP to study participants. Further research investigating how behaviours and PrEP preferences change correspondingly over time is needed. Trial registration ClinicalTrials.gov NCT02206555. Registered 28 July 2014.
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Affiliation(s)
| | | | - David J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,RPA Sexual Health, Sydney Local Health District and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Catriona Ooi
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Rosalind Foster
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Clinic 16 Northern Sydney Sexual Health, Royal North Shore Community Health Centre, St Leonards, NSW, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia.,School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
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Vaccher SJ, Grulich AE, Haire BG, Conway DP, Poynten IM, Ooi C, Foster R, Templeton DJ, Zablotska IB. Validation of participant eligibility for pre-exposure prophylaxis: Baseline data from the PRELUDE demonstration project. PLoS One 2017; 12:e0185398. [PMID: 28950022 PMCID: PMC5614574 DOI: 10.1371/journal.pone.0185398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/10/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In Australia, pre-exposure prophylaxis (PrEP) is targeted to individuals at high risk for HIV infection. We describe the HIV risk profile and characteristics of PRELUDE participants, and evaluate the population validity of the sample in representing high-risk gay and bisexual men (GBM) eligible for PrEP. METHODS PRELUDE is an on-going, open-label, single-arm observational study. Participants were identified in clinics and screened for eligibility using a paper-based risk assessment tool which followed the New South Wales (NSW) PrEP guidelines. Selection was validated using an independent online behavioural survey, completed by study participants upon enrolment. Demographic information was analysed using descriptive statistics, and kappa tests were used to determine agreement between reporting of high-risk practices in the risk assessment and behavioural survey. RESULTS During 2014-15, 471 individuals were targeted for enrolment; 341 were assessed for PrEP eligibility and 313 were enrolled. Of these, 303 (97%) identified as GBM. Overall, 85% of GBM met at least one high-risk criterion; 68% reported receptive intercourse with an HIV-positive or unknown status casual male partner, and 37% reported methamphetamine use in the three months preceding enrolment. The remaining 15% were enrolled based on medium-risk behaviours, or at the clinicians' discretion. We found an 82% total agreement between self-reported high-risk behaviour and clinicians' categorisation of GBM as being at high risk for HIV based on PrEP eligibility criteria. CONCLUSIONS Behavioural eligibility criteria used by clinicians successfully identified individuals at high risk for HIV infection. This targeted approach ensures that the greatest public health and HIV prevention benefits can be derived in a setting without universal access to PrEP.
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Affiliation(s)
- Stefanie J. Vaccher
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- * E-mail: (SJV); (IBZ)
| | - Andrew E. Grulich
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Bridget G. Haire
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Damian P. Conway
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Isobel M. Poynten
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Catriona Ooi
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia
| | - Rosalind Foster
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- Clinic 16, Northern Sydney Sexual Health, St Leonards, New South Wales, Australia
| | - David J. Templeton
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- RPA Sexual Health, Sydney Local Health District and Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Iryna B. Zablotska
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- * E-mail: (SJV); (IBZ)
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