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Holt M, Chan C, Broady TR, MacGibbon J, Mao L, Smith AKJ, Rule J, Bavinton BR. Variations in HIV Prevention Coverage in Subpopulations of Australian Gay and Bisexual Men, 2017-2021: Implications for Reducing Inequities in the Combination Prevention Era. AIDS Behav 2024; 28:1469-1484. [PMID: 37755522 PMCID: PMC11069488 DOI: 10.1007/s10461-023-04172-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/28/2023]
Abstract
Using repeated behavioural surveillance data collected from gay and bisexual men (GBM) across Australia, we assessed trends in HIV prevention coverage (the level of 'safe sex' achieved in the population by the use of effective prevention methods, including condoms, pre-exposure prophylaxis [PrEP] and having an undetectable viral load). We stratified these trends by age, country of birth/recency of arrival, sexual identity, and the proportion of gay residents in the participant's suburb. Among 25,865 participants with casual male partners, HIV prevention coverage increased from 69.8% in 2017 to 75.2% in 2021, lower than the UNAIDS target of 95%. Higher levels of coverage were achieved among older GBM (≥ 45 years), non-recently-arrived migrants, and in suburbs with ≥ 10% gay residents. The lowest levels of prevention coverage (and highest levels of HIV risk) were recorded among younger GBM (< 25 years) and bisexual and other-identified participants. Younger, recently-arrived, and bisexual GBM were the most likely to use condoms, while PrEP use was concentrated among gay men, 25-44-year-olds, and in suburbs with more gay residents. The use of undetectable viral load was most common among participants aged ≥ 45 years. Our analysis shows that high HIV prevention coverage can be achieved through a mixture of condom use, PrEP use, and undetectable viral load, or by emphasising PrEP use. In the Australian context, younger, bisexual and other-identified GBM should be prioritised for enhanced access to effective HIV prevention methods. We encourage other jurisdictions to assess the level of coverage achieved by combination prevention, and variations in uptake.
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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
| | - James MacGibbon
- 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
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - John Rule
- National Association of People With HIV Australia, Sydney, Australia
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Seib KL, Donovan B, Thng C, Lewis DA, McNulty A, Fairley CK, Yeung B, Jin F, Fraser D, Bavinton BR, Law M, Chen MY, Chow EPF, Whiley DM, Mackie B, Jennings MP, Jennison AV, Lahra MM, Grulich AE. Multicentre double-blind randomised placebo-controlled trial evaluating the efficacy of the meningococcal B vaccine, 4CMenB (Bexsero), against Neisseria gonorrhoeae infection in men who have sex with men: the GoGoVax study protocol. BMJ Open 2024; 14:e081675. [PMID: 38626958 PMCID: PMC11029339 DOI: 10.1136/bmjopen-2023-081675] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Gonorrhoea, the sexually transmissible infection caused by Neisseria gonorrhoeae, has a substantial impact on sexual and reproductive health globally with an estimated 82 million new infections each year worldwide. N. gonorrhoeae antimicrobial resistance continues to escalate, and disease control is largely reliant on effective therapy as there is no proven effective gonococcal vaccine available. However, there is increasing evidence from observational cohort studies that the serogroup B meningococcal vaccine four-component meningitis B vaccine (4CMenB) (Bexsero), licensed to prevent invasive disease caused by Neisseria meningitidis, may provide cross-protection against the closely related bacterium N. gonorrhoeae. This study will evaluate the efficacy of 4CMenB against N. gonorrhoeae infection in men (cis and trans), transwomen and non-binary people who have sex with men (hereafter referred to as GBM+). METHODS AND ANALYSIS This is a double-blind, randomised placebo-controlled trial in GBM+, either HIV-negative on pre-exposure prophylaxis against HIV or living with HIV (CD4 count >350 cells/mm3), who have had a diagnosis of gonorrhoea or infectious syphilis in the last 18 months (a key characteristic associated with a high risk of N. gonorrhoeae infection). Participants are randomised 1:1 to receive two doses of 4CMenB or placebo 3 months apart. Participants have 3-monthly visits over 24 months, which include testing for N. gonorrhoeae and other sexually transmissible infections, collection of demographics, sexual behaviour risks and antibiotic use, and collection of research samples for analysis of N. gonorrhoeae-specific systemic and mucosal immune responses. The primary outcome is the incidence of the first episode of N. gonorrhoeae infection, as determined by nucleic acid amplification tests, post month 4. Additional outcomes consider the incidence of symptomatic or asymptomatic N. gonorrhoeae infection at different anatomical sites (ie, urogenital, anorectum or oropharynx), incidence by N. gonorrhoeae genotype and antimicrobial resistance phenotype, and level and functional activity of N. gonorrhoeae-specific antibodies. ETHICS AND DISSEMINATION Ethical approval was obtained from the St Vincent's Hospital Human Research Ethics Committee, St Vincent's Hospital Sydney, NSW, Australia (ref: 2020/ETH01084). Results will be disseminated in peer-reviewed journals and via presentation at national and international conferences. TRIAL REGISTRATION NUMBER NCT04415424.
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Affiliation(s)
- Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Caroline Thng
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Sexual Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Sydney, New South Wales, Australia
- Sydney Medical School - Westmead, Faculty of Medicine and Health and Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Barbara Yeung
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Doug Fraser
- The Kirby Institute, 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
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - David M Whiley
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Michael P Jennings
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Amy V Jennison
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, Queensland, Australia
| | - Monica M Lahra
- WHO Collaborating Centre for STI and AMR, New South Wales Health Pathology Microbiology, The Prince of Wales Hospital, Sydney, New South Wales, Australia
- UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Bavinton BR, Dharan NJ. Cost-effectiveness of the expansion of PrEP for HIV infection in the Asia Pacific region. Lancet Glob Health 2024; 12:e177-e178. [PMID: 38245105 DOI: 10.1016/s2214-109x(23)00600-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Benjamin R Bavinton
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Nila J Dharan
- Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nakiganda LJ, Bavinton BR, Poynten IM, Serwadda D, Bazaale JM, Grulich AE. Sexual pleasure and HIV-related worry in female sex workers on oral pre-exposure prophylaxis in south-western Uganda. Sex Health 2024; 21:SH23056. [PMID: 38267368 DOI: 10.1071/sh23056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Female sex workers (FSWs) contribute disproportionately to HIV transmission in Uganda, and pre-exposure prophylaxis (PrEP) is effective in preventing HIV among cisgender women. Psychological factors are important for PrEP uptake, but few studies have examined psychosocial changes due to PrEP use in Uganda. METHODS In 2021, we recruited 524 FSWs in three Trans-African Highway towns and four fishing communities in south-western Uganda. We conducted structured interviews among women who were attending routine PrEP follow-up visits in six health units. Bivariable and multivariable modified regression using a robust covariance matrix estimator were used to identify factors associated with experiencing increased sexual pleasure and less worry about HIV because of PrEP. RESULTS Overall, 80.9% participants reported that sex was more pleasurable because of taking PrEP. There were statistical trends for sex being more pleasurable when taking PrEP or when having condomless sex with casual paying partners (aPR=1.19, 95% CI=1.07-1.32, P =0.001). Almost three-quarters of the participants (76.3%) were less worried about getting HIV because of PrEP. Condomless sex with casual paying partners (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) and being On PrEP for the past 1-2years (aPR=1.18, 95% CI=1.00-1.38, P =0.032) was significantly associated with HIV-related worry (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) Conclusions : We found a positive impact of PrEP in Ugandan FSWs on two key psychosocial dimensions: (1) more pleasurable sex; and (2) less worry about acquiring HIV. Interventions aiming to increase PrEP uptake may find it useful to focus on psychosocial dimensions.
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Affiliation(s)
| | - Benjamin R Bavinton
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
| | - Isobel Mary Poynten
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda; and Makerere University School of Public Health, Kampala, Uganda
| | | | - Andrew E Grulich
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, NSW, Australia
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Chan C, Holt M, Broady TR, Traeger MW, Mao L, Grulich AE, Prestage G, MacGibbon J, Rule J, Bavinton BR. Trends in Testing and Self-Reported Diagnoses of Sexually Transmitted Infections in Gay and Bisexual Men in Australia, 2017 to 2021: Analysis of National Behavioral Surveillance Surveys. Sex Transm Dis 2023; 50:789-795. [PMID: 37820259 DOI: 10.1097/olq.0000000000001870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBM) are overrepresented in diagnoses of sexually transmitted infections (STIs) relative to their population size. This study assessed trends in STI testing and diagnoses among GBM in Australia. METHODS The Gay Community Periodic Surveys are repeated cross-sectional behavioral surveillance surveys of GBM. Participants reported the number of anal swabs, throat swabs, urine samples, and blood tests for syphilis they undertook in the last year. "Frequent comprehensive testing" was defined as ≥3 of each test in the previous year. Participants reported STI diagnoses of chlamydia, gonorrhea, syphilis, and other STIs in the last year. Trends in testing and diagnoses from 2017 to 2020 and 2020 to 2021 were assessed with logistic regression models. RESULTS We analyzed 24,488 survey responses from participants reporting casual sex in the last 6 months. Between 2017 and 2020, frequent comprehensive STI testing decreased among HIV-negative GBM on preexposure prophylaxis (PrEP) from 71.7% to 68.9% and declined further to 58.6% in 2021. Frequent comprehensive STI testing was stable during 2017-2020 among HIV-negative/untested GBM not on PrEP (17.4%-14.6%) and HIV-positive GBM (30.4%-35.1%) but declined in 2021 to 7.5% among non-PrEP-users and 25.7% among HIV-positive participants. There were minimal changes in STI diagnoses during 2017-2020, but diagnoses declined in 2021. CONCLUSIONS Many GBM do not meet Australian STI testing guidelines that recommend quarterly testing. Further evaluation of whether this recommendation is realistic or necessary to reduce STIs among GBM is recommended.
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Affiliation(s)
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney
| | | | | | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney
| | | | | | | | - John Rule
- National Association of People With HIV Australia, Sydney, Australia
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Zhang Y, Holt M, Chan C, Applegate TL, Bavinton BR, Broady TR, Keen P, Wulandari LPL, Mao L, McManus H, Medland NA, Prestage G, Wiseman V, Guy RJ. National Surveillance of Home-Based HIV Testing Among Australian Gay and Bisexual Men, 2018-2020: Uptake After Commercial Availability of HIV Self-Tests. AIDS Behav 2023; 27:4106-4113. [PMID: 37439916 PMCID: PMC10598086 DOI: 10.1007/s10461-023-04124-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
HIV self-testing allows people to collect samples and test themselves at home, addressing known barriers to facility-based testing. We aimed to measure the uptake of home HIV testing among Australian gay and bisexual men (GBM). Using national cross-sectional data from the Australian Gay Community Periodic Surveys, we assessed trends in home HIV testing among non-HIV positive GBM between 2018 and 2020. Overall, the use of home HIV testing was low, but slightly increased during 2018-2020 (from 0.3 to 0.8%, RR = 1.54, 95%CI = 1.23-1.92, p-trend < 0.001). Testing at home was more likely among non-HIV-positive GBM who were born overseas and recently arrived in Australia, at higher risk of HIV, and infrequent HIV testers. Given the greater use of home testing by men at higher risk of HIV, recent migrants and infrequent testers, all priority groups in Australia's HIV epidemic, we recommend increasing access to HIV self-testing to enhance uptake in these and other groups of GBM.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia.
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Curtis Chan
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Tanya L Applegate
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Luh Putu Lila Wulandari
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Hamish McManus
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Nicholas A Medland
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Garrett Prestage
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
| | - Virginia Wiseman
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca J Guy
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, Sydney, NSW, 2031, Australia
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Chan C, Mao L, Bavinton BR, Holt M, Prankumar SK, Dong K, Wark T, Chen T, Wijaya HY, Wong HTH. The impact of social connections and discrimination to HIV risk among Asian gay and bisexual men in Australia. Sex Health 2023; 20:479-487. [PMID: 37743096 DOI: 10.1071/sh23036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Asian gay, bisexual, and other men who have sex with men (GBMSM) are overrepresented in new HIV diagnoses in Australia. Social engagement with other GBMSM has been associated with HIV testing and pre-exposure prophylaxis (PrEP) uptake. Asian GBMSM may be socially disconnected from LGBTQ+ people, which may increase their HIV risk. This analysis assessed the contribution of social connection on HIV risk among Asian GBMSM. METHODS Using an online cross-sectional survey of Asian GBMSM in Australia, we measured condomless anal intercourse (CLAI) in the last 6months without PrEP or an undetectable viral load (UVL), i.e. CLAI with a risk of HIV transmission. Bivariable and multivariable logistic regression models were performed to compare demographic characteristics and social engagement of participants who had CLAI without PrEP or UVL to those who had not. Analyses were restricted to participants who reported sex with casual partners in the last 6months. RESULTS Among 509 participants who had casual partners in the last 6months, 151 (29.7%) reported CLAI without PrEP or UVL. CLAI without PrEP or UVL was negatively associated with full-time employment, and recently being tested for HIV and was positively associated with experiencing discrimination based on sexual orientation. Social engagement with LGBTQ+ people was not associated with CLAI without PrEP or UVL. CONCLUSIONS CLAI without PrEP or UVL was not related to social connections with LGBTQ+ people but was more likely among Asian men who had experienced sexuality-related discrimination, suggesting that mitigating homophobia and biphobia may assist in improving HIV prevention among Asian GBMSM who live in Australia.
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Affiliation(s)
- Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sujith Kumar Prankumar
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Kevin Dong
- Western Sydney Sexual Health Centre, Sydney, NSW, Australia
| | | | | | | | - Horas T H Wong
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia; and Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
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MacGibbon J, Cornelisse VJ, Smith AKJ, Broady TR, Hammoud MA, Bavinton BR, Heath-Paynter D, Vaughan M, Wright EJ, Holt M. Mpox (monkeypox) knowledge, concern, willingness to change behaviour, and seek vaccination: results of a national cross-sectional survey. Sex Health 2023; 20:403-410. [PMID: 37611539 DOI: 10.1071/sh23047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND In mid-2022, a global mpox (formerly 'monkeypox') outbreak affecting predominantly gay and bisexual men emerged in non-endemic countries. Australia had never previously recorded mpox cases and there was no prior research on knowledge or attitudes to mpox among gay and bisexual men across Australia. METHODS We conducted a national, online cross-sectional survey between August 2022 and September 2022. Participants were recruited through community organisation promotions, online advertising, and direct email invitations. Eligible participants were gay, bisexual or queer; identified as male (cisgender or transgender) or non-binary; aged 16years or older; and lived in Australia. The main outcome measures were: knowledge and concern about mpox; recognition of mpox symptoms and transmission routes; vaccination history; acceptability of behavioural changes to reduce mpox risk, and willingness to be vaccinated. RESULTS Of 2287 participants, most participants were male (2189/2287; 95.7%) and gay (1894/2287; 82.8%). Nearly all had heard about mpox (2255/2287; 98.6%), and the majority were concerned about acquiring it (1461/2287; 64.4%). Most of the 2268 participants not previously diagnosed with mpox correctly identified skin lesions (2087; 92%), rash (1977; 87.2%), and fever (1647; 72.6%) as potential symptoms, and prolonged and brief skin-to-skin contact as potential ways to acquire mpox (2124, 93.7%; and 1860, 82%, respectively). The most acceptable behavioural changes were reducing or avoiding attendance at sex parties (1494; 65.9%) and sex-on-premises venues (1503; 66.4%), and having fewer sexual partners (1466; 64.6%). Most unvaccinated and undiagnosed participants were willing to be vaccinated (1457/1733; 84.1%). CONCLUSIONS People at risk of mpox should be supported to adopt acceptable risk reduction strategies during outbreaks and to seek vaccination.
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Affiliation(s)
- James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Vincent J Cornelisse
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and NSW Health, Sydney, NSW, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Edwina J Wright
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Vic., Australia; and Burnet Institute, Melbourne, Vic., Australia; and The Peter Doherty Institute of Infection and Immunity, Melbourne, Vic., Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
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Broady TR, Chan C, MacGibbon J, Mao L, Prestage G, Clifton B, Paynter H, Bavinton BR, Holt M. Changing Characteristics of HIV-Positive Gay and Bisexual Men's Relationships in the Era of Biomedical Prevention. J Acquir Immune Defic Syndr 2023; 94:10-17. [PMID: 37195893 DOI: 10.1097/qai.0000000000003224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/06/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To assess changes in personal and relationship characteristics among HIV-positive Australian gay and bisexual men (GBM) as rates of antiretroviral therapy and knowledge and confidence regarding the effectiveness of viral suppression in preventing HIV transmission have increased. DESIGN Repeated behavioral surveillance of GBM recruited from venues, events, and online in 7 Australian states and territories. METHODS HIV-positive participants were included. Trends in demographics, HIV treatment, and relationship characteristics were assessed with binary and multivariable logistic regression. RESULTS A total of 3643 survey responses (2016-2020) were included. Over time, HIV-positive GBM became less likely to identify as gay or report an Anglo-Australian ethnicity. The average length of time since HIV diagnosis increased and the frequency of attending HIV-related clinical appointments decreased. There were no changes in the reported number of recent sex partners or proportion reporting regular male partners over time. Among HIV-positive GBM in relationships, the proportion reporting HIV-positive partners decreased and the proportion reporting HIV-negative partners increased. Levels of condomless sex with regular partners increased over time; however, this was concentrated among HIV-positive GBM in serodiscordant relationships. CONCLUSION Findings suggest that increased accessibility and trust in biomedical prevention strategies have contributed to broader relationship and sexual opportunities for HIV-positive GBM in Australia. Our findings suggest that future health promotion activities could highlight the social and relationship benefits of treatment as prevention to further increase trust in it as an HIV prevention strategy among GBM.
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Affiliation(s)
- Timothy R Broady
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Curtis Chan
- Kirby Institute, UNSW, Sydney, NSW, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | | | - Brent Clifton
- National Association of People With HIV Australia, Sydney, NSW, Australia; and
| | | | | | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
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12
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MacGibbon J, Bavinton BR, Broady TR, Ellard J, Murphy D, Calabrese SK, Kalwicz DA, Heath-Paynter D, Molyneux A, Power C, Heslop A, de Wit J, Holt M. Corrigendum to: Familiarity with, perceived accuracy of, and willingness to rely on Undetectable=Untransmittable (U=U) among gay and bisexual men in Australia: results of a national cross-sectional survey. Sex Health 2023; 20:373. [PMID: 37603535 DOI: 10.1071/sh23050_co] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND The Undetectable=Untransmittable (U=U) message has been promoted since it was demonstrated that viral suppression through HIV treatment prevents sexual transmission between serodiscordant partners (HIV treatment as prevention). Our study assessed familiarity with, perceived accuracy of, and willingness to rely on U=U in a national sample of gay and bisexual men in Australia. METHODS We conducted a national, online cross-sectional survey in April-June 2021. Eligible participants were gay, bisexual and queer men and non-binary people who lived in Australia. Logistic regression was used to identify factors associated with familiarity, perceived accuracy and willingness to rely on U=U (by having condomless sex with a partner with HIV who has an undetectable viral load). RESULTS Of 1280 participants, most were familiar with U=U (1006/1280; 78.6%), the majority of whom believed U=U was accurate (677/1006; 67.3%). Both familiarity and perceived accuracy were higher among participants living with HIV, followed by pre-exposure prophylaxis (PrEP) users, HIV-negative participants not taking PrEP, and untested/unknown status participants. Knowing at least one person living with HIV, among other factors, was associated with familiarity and perceived accuracy of U=U; and familiarity was associated with perceived accuracy. Among participants familiar with U=U, less than half were willing to rely on U=U (473/1006; 47.0%). Familiarity with U=U and knowing at least one person living with HIV were associated with willingness to rely on U=U, among other factors. CONCLUSIONS We found familiarity with U=U was associated with perceived accuracy and willingness to rely upon it. There is an ongoing need to educate gay and bisexual men (particularly HIV-negative men) about U=U and its benefits.
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13
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Tieosapjaroen W, Zhang Y, Fairley CK, Zhang L, Chow EPF, Phillips TR, Schmidt HM, Bavinton BR, O'Donnell D, Mao L, Grulich A, Ong JJ. Improving access to oral pre-exposure prophylaxis for HIV among international migrant populations. Lancet Public Health 2023; 8:e651-e658. [PMID: 37421969 DOI: 10.1016/s2468-2667(23)00105-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is recommended for people susceptible to HIV acquisition, and the scale-up of PrEP programmes has contributed to new HIV case reductions at a population level. However, international migrants continue to be disproportionately affected by HIV. Understanding barriers and facilitators to PrEP implementation among international migrants can optimise PrEP use among this population and ultimately reduce HIV incidence worldwide. We reviewed the evidence regarding factors influencing PrEP implementation among international migrants; 19 studies were included. The barriers and facilitators at the individual level were related to knowledge and risk perception of HIV. Cost, provider discriminations, and health system navigation influenced PrEP use at the service level. Positive or negative perception towards LGBT+ identities, HIV, and PrEP users affected PrEP use at the societal level. Most existing PrEP campaigns do not target international migrants; therefore, culturally tailored approaches for people from different backgrounds are warranted. Potentially migration-related and HIV-related discriminatory policies must be reviewed to increase access to HIV prevention services to end HIV transmission at a population level.
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Affiliation(s)
- Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ying Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Heather-Marie Schmidt
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand; Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland
| | | | - Darryl O'Donnell
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Australian Federation of AIDS Organisations, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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14
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MacGibbon J, Bavinton BR, Broady TR, Ellard J, Murphy D, Calabrese SK, Kalwicz DA, Heath-Paynter D, Molyneux A, Power C, Heslop A, de Wit J, Holt M. Familiarity with, perceived accuracy of, and willingness to rely on Undetectable=Untransmittable (U=U) among gay and bisexual men in Australia: results of a national cross-sectional survey. Sex Health 2023:SH23050. [PMID: 37380171 DOI: 10.1071/sh23050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The Undetectable=Untransmittable (U=U) message has been promoted since it was demonstrated that viral suppression through HIV treatment prevents sexual transmission between serodiscordant partners (HIV treatment as prevention). Our study assessed familiarity with, perceived accuracy of, and willingness to rely on U=U in a national sample of gay and bisexual men in Australia. METHODS We conducted a national, online cross-sectional survey in April-June 2021. Eligible participants were gay, bisexual and queer men and non-binary people who lived in Australia. Logistic regression was used to identify factors associated with familiarity, perceived accuracy and willingness to rely on U=U (by having condomless sex with a partner with HIV who has an undetectable viral load). RESULTS Of 1280 participants, most were familiar with U=U (1006/1280; 78.6%), the majority of whom believed U=U was accurate (677/1006; 67.3%). Both familiarity and perceived accuracy were higher among participants living with HIV, followed by pre-exposure prophylaxis (PrEP) users, HIV-negative participants not taking PrEP, and untested/unknown status participants. Knowing at least one person living with HIV, among other factors, was associated with familiarity and perceived accuracy of U=U; and familiarity was associated with perceived accuracy. Among participants familiar with U=U, less than half were willing to rely on U=U (473/1006; 47.0%). Familiarity with U=U and knowing at least one person living with HIV were associated with willingness to rely on U=U, among other factors. CONCLUSIONS We found familiarity with U=U was associated with perceived accuracy and willingness to rely upon it. There is an ongoing need to educate gay and bisexual men (particularly HIV-negative men) about U=U and its benefits.
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15
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Ung M, Martin S, Terris-Prestholt F, Quaife M, Tieosapjaroen W, Phillips T, Lee D, Chow EPF, Medland N, Bavinton BR, Pan SW, Mao L, Ong JJ. Preferences for HIV prevention strategies among newly arrived Asian-born men who have sex with men living in Australia: A discrete choice experiment. Front Public Health 2023; 11:1018983. [PMID: 36992887 PMCID: PMC10040803 DOI: 10.3389/fpubh.2023.1018983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
The HIV epidemic in Australia is changing with higher risk for HIV among newly-arrived Asian-born men who have sex with men (MSM) compared to Australian-born MSM. We evaluated the preferences for HIV prevention strategies among 286 Asian-born MSM living in Australia for <5 years. A latent class analysis uncovered three classes of respondents who were defined by their preferences: “PrEP” (52%), “Consistent condoms” (31%), and “No strategy” (17%). Compared to the “No strategy” class, men in the “PrEP” class were less likely to be a student or ask their partner for their HIV status. Men in the “Consistent condoms” class were more likely to get information about HIV from online, and less likely to ask their partner for their HIV status. Overall, PrEP was the preferred HIV prevention strategy for newly arrived migrants. Removing structural barriers to access PrEP can accelerate progress toward ending HIV transmission.
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Affiliation(s)
- Megan Ung
- Department of Infectious Diseases and Microbiology, Concord Hospital, Sydney, NSW, Australia
| | - Sarah Martin
- Canberra Sexual Health Centre, Canberra, ACT, Australia
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tiffany Phillips
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Nick Medland
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Stephen W. Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
- University of Liverpool, Liverpool, United Kingdom
| | - Limin Mao
- Centre for Social Research and Health, University of Sydney, Sydney, NSW, Australia
| | - Jason J. Ong
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Melbourne Sexual Health Centre, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- *Correspondence: Jason J. Ong
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16
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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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17
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Philpot SP, Murphy D, Chan C, Haire B, Wells N, Fraser D, Grulich AE, Bavinton BR. Identifying Patterns of Discontinuing and Recommencing Pre-exposure Prophylaxis in the Context of Sexual Behavior Among Gay and Bisexual Men in Australia. AIDS Behav 2023:10.1007/s10461-023-04013-3. [PMID: 36811738 PMCID: PMC9945832 DOI: 10.1007/s10461-023-04013-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
We mapped gay and bisexual men's (GBM) patterns of using pre-exposure prophylaxis (PrEP) over time and explored sexual behavior as PrEP use changed. We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBM living in Australia who had changed their PrEP use since initiating. There was considerable diversity in patterns of discontinuation, suspension, and recommencement of PrEP. Reasons for changing PrEP use mostly centered on accurate perceived changes to HIV risk. Twelve participants reported condomless anal intercourse with casual or fuckbuddy partners after discontinuing PrEP. These sex events were unanticipated, condoms were not a preferred option, and other risk reduction strategies were applied inconsistently. Service delivery and health promotion can support safer sex among GBM when PrEP use fluctuates by promoting event-driven PrEP and/or non-condom-based risk reduction methods during periods off daily PrEP, and guiding GBM to better recognize changing circumstances of risk and when to recommence PrEP.
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Affiliation(s)
- Steven P. Philpot
- Level 6, Wallace Wurth Building, High St, Kensington, NSW 2052 Australia
| | - Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, Australia ,Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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18
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MacGibbon J, Bavinton BR, Drysdale K, Murphy D, Broady TR, Kolstee J, Molyneux A, Power C, Paynter H, de Wit J, Holt M. Explicit Relationship Agreements and HIV Pre-exposure Prophylaxis Use by Gay and Bisexual Men in Relationships. Arch Sex Behav 2023; 52:761-771. [PMID: 35939159 PMCID: PMC9360633 DOI: 10.1007/s10508-022-02382-9] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Relationship agreements are important for HIV prevention among gay and bisexual men (GBM) in relationships, with research earlier in the HIV epidemic often finding that agreements specified monogamy or condom use with casual partners. There is evidence that HIV pre-exposure prophylaxis (PrEP) has shifted sexual practices among some men in relationships, such as allowing condomless sex with casual partners, but there has been little attention paid to relationship agreements among GBM who use PrEP. In this paper, we analyzed national, Australian, cross-sectional data from an online survey completed by non-HIV-positive GBM in 2021 (N = 1,185). Using logistic regression, we identified demographic characteristics, sexual practices and the types of relationship agreement that were associated with PrEP use among GBM in relationships. Using Pearson's chi-squared tests, we explored whether PrEP users in relationships reported similar sexual practices to PrEP users not in relationships. PrEP use among GBM in relationships was independently associated with older age, identifying as gay, being in a non-monogamous relationship, having a spoken (explicit) relationship agreement, having a primary HIV-negative partner taking PrEP or a primary partner living with HIV, reporting recent condomless casual sex, reporting an STI diagnosis in the past year, and knowing at least one other PrEP user. We found that PrEP users in relationships had similar sexual practices to PrEP users not in relationships. GBM in relationships who have casual sex and who meet PrEP suitability criteria may be good candidates for PrEP. Our findings suggest that explicit relationship agreements remain important for HIV prevention, and they support PrEP use among GBM in relationships.
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Affiliation(s)
- James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia.
| | | | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia
| | - Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia
| | | | | | - Cherie Power
- New South Wales Ministry of Health, Sydney, Australia
| | - Heath Paynter
- Australian Federation of AIDS Organisations, Sydney, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, 2052, Australia
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Medland NA, Fraser D, Bavinton BR, Jin F, Grulich AE, Paynter H, Guy R, McManus H. Discontinuation of government subsidized HIV pre-exposure prophylaxis in Australia: a whole-of-population analysis of dispensing records. J Int AIDS Soc 2023; 26:e26056. [PMID: 36707247 PMCID: PMC9883116 DOI: 10.1002/jia2.26056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/20/2022] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION HIV pre-exposure prophylaxis (PrEP) has been government subsidized in Australia since April 2018 and while uptake is high among men who have sex with men, rates of discontinuation are also high. The aims of this study were to examine the impact of discontinuation on overall PrEP usage, the proportion of PrEP users who discontinue and the predictors of discontinuation. METHODS We used linked de-identified dispensing records of all government subsidized PrEP in Australia between April 2018 and September 2021: a whole-of-population data set. Defining discontinuation as 180 days or more without PrEP after the final dispensed supply, we calculated the number of people who discontinued at each 6-month interval during the study period, the proportion who had discontinued 2 years after the first supply and, using Cox regression, predictors of discontinuation. RESULTS Of 49,164 people dispensed PrEP (98.5% male, median age 34 years), 40.3% (19,815) had discontinued by September 2021. Within 2 years of their first supply, 11,150 (37.7%) of 29,549 PrEP users had discontinued, including 10.0% after a single dispensed supply. Large variations were observed, particularly according to prescriber characteristics: discontinuation was higher among people prescribed PrEP by low caseload (≤10 patients) prescribers (61.2%) than by high caseload (>100 patients) prescribers (31.1%, p<0.001), and by prescribers practising in areas with low estimated prevalence (<1.0%) of gay men (64.1%) than high (>5%) prevalence (36.7%, p<0.001). Women and younger people were more likely to discontinue, while patients receiving a higher level of government subsidy were less likely. The independent predictors of discontinuation with the greatest effect size were female sex (adjusted hazards ratio [aHR] 2.99, p<0.001), low estimated gay prevalence of prescriber location (aHR 1.98, p<0.001) and low prescriber PrEP caseload (aHR 1.79, p<0.001). CONCLUSIONS There are high rates of PrEP discontinuation in Australia and some populations are at increased risk of discontinuation. Strategies are needed to support persistence on PrEP and the re-starting of PrEP during periods of risk.
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Affiliation(s)
- Nicholas Andrew Medland
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia,Melbourne Sexual Health CentreMonash University Central Clinical SchoolMelbourneVictoriaAustralia
| | - Doug Fraser
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Fengyi Jin
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Andrew E. Grulich
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Heath Paynter
- Australian Federation of AIDS OrganisationsSydneyNew South WalesAustralia
| | - Rebecca Guy
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Hamish McManus
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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Abraham E, Chow EPF, Fairley CK, Lee D, Kong FYS, Mao L, Goller JL, Medland N, Bavinton BR, Sudarto B, Joksic S, Wong J, Phillips TR, Ong JJ. eSexualHealth: Preferences to use technology to promote sexual health among men who have sex with men and trans and gender diverse people. Front Public Health 2023; 10:1064408. [PMID: 36711397 PMCID: PMC9877518 DOI: 10.3389/fpubh.2022.1064408] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Objectives Gay, bisexual and other men who have sex with men (GBMSM) and trans and gender diverse (TGD) people are disproportionately affected by poorer sexual health outcomes compared to heterosexual populations. We aimed to explore the preferences of GBMSM and TGD for using eHealth for sexual health (eSexualHealth). Methods We distributed an anonymous online survey from April to August 2021among the lesbian, gay, bisexual, transgender, intersex, queer and other people of diverse sexuality or gender (LGBTIQA+) community in Australia. The survey collected data on sociodemographic characteristics and sexual behaviors, their preferences for app/website functions and preferred HIV and sexually transmitted infection (STI) testing reminders. We used descriptive statistics to summarize the characteristics of the study population. Free-text responses were thematically analyzed. Results Of 466 participants included, most identified as cisgender males (92.7%). The median age was 48 [interquartile range (IQR): 37-56]. For accessing sexual health-related information, 160 (34.6%) would use either a website or an app, 165 (32.7%) would prefer a website, 119 (25.8%) would prefer an app, and 33 (7.1%) would not use either platform. There was no significant difference between GBMSM and TGD people. Participants were most interested in information about STI clinics, HIV/STI hotspots, and sexual health education. Participants stressed the need for privacy and anonymity when using eHealth. Regarding reminders to test for HIV/STIs, receiving regular SMS was most popular (112/293, 38.2%), followed by regular emails (55/293 18.8%) and a reminder function on their phone (48/293, 16.4%). Conclusion Our study suggests a promising future for eHealth among GBMSM and TGD people. Sexual health is still a stigmatized area, and eHealth may circumvent barriers this population faces.
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Affiliation(s)
- Esha Abraham
- Central Clinical School, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Eric P. F. Chow
- Central Clinical School, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christopher K. Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Fabian Y. S. Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Jane L. Goller
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas Medland
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Budiadi Sudarto
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | | | - Tiffany R. Phillips
- Central Clinical School, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jason J. Ong
- Central Clinical School, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom,*Correspondence: Jason J. Ong ✉
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Chan C, Fraser D, Grulich AE, Philpot S, Vaughan M, Wacher M, Bavinton BR. Increased awareness of event-driven PrEP and knowledge of how to use it: results from a cross-sectional survey of gay and bisexual men in Australia. Sex Health 2022; 19:501-508. [PMID: 35919968 DOI: 10.1071/sh22101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent changes to Australian PrEP prescribing guidelines support the use of event-driven pre-exposure prophylaxis (ED-PrEP) to prevent HIV among gay and bisexual men (GBM). Social marketing campaigns to increase awareness of ED-PrEP were conducted in early 2021. This study aimed to assess the awareness and knowledge of this method after these campaigns. METHODS We conducted a national cross-sectional online survey about PrEP knowledge and attitudes from March to May 2021. Participants were asked if they had heard of ED-PrEP. Among aware participants, questions about the '2-1-1' method were asked to assess knowledge. Bivariate and multivariate logistic regression analyses were conducted to assess the characteristics of those who were aware of ED-PrEP, and those who had correct knowledge of ED-PrEP. Analysis was restricted to non-HIV-positive cis-GBM who were aware of PrEP. RESULTS Among the 419 participants eligible for this analysis, 286 (68.3%) had heard of ED-PrEP. Awareness was associated with living in a postcode with ≥10% gay men, PrEP experience, and belief ED-PrEP is effective. Of these 286 participants, 125 (43.7%) correctly answered questions about how to take ED-PrEP. Correct knowledge was associated with PrEP experience and belief ED-PrEP is effective. CONCLUSIONS A growing proportion of GBM are aware of ED-PrEP, but many still do not know how to take it as per clinical guidelines. More work is needed to increase knowledge among GBM to promote effective use of this method.
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Affiliation(s)
- Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Steven Philpot
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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23
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Kolstee J, MacGibbon J, Prestage G, Clackett S, Paynter H, Bavinton BR, Broady TR, Ellard J, Murphy DA, de Wit J, Power C, Holt M. Changing Attitudes Towards Condoms Among Australian Gay and Bisexual Men in the PrEP Era: An Analysis of Repeated National Online Surveys 2011-2019. AIDS Educ Prev 2022; 34:453-466. [PMID: 36454135 DOI: 10.1521/aeap.2022.34.6.453] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Condoms have been the primary form of HIV prevention for gay and bisexual men (GBM) for most of the HIV epidemic. The introduction of biomedical HIV prevention may have changed attitudes towards condoms. Data from repeated national online surveys of GBM in Australia were used to examine how attitudes towards condoms and confidence discussing condoms with partners changed in the period 2011-2019. The proportion of all participants who reported a positive experience in using condoms remained low and unchanged (9.6% in 2011 to 6.0% in 2019). Confidence in discussing condoms with partners decreased over time (from 72.2% in 2011 to 56.6% in 2019). Confidence in discussing condoms was associated with concern about sexually transmitted infections, and more consistent condom use. Sustaining confidence in using condoms may be more challenging as biomedical prevention methods become more commonly used.
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Affiliation(s)
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Australia
| | | | | | - Heath Paynter
- Australian Federation of AIDS Organisations, Sydney, Australia
| | | | | | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | | | - John de Wit
- Kirby Institute, UNSW Sydney, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Australia
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24
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Newman CE, Fraser D, Ong JJ, Bourne C, Grulich AE, Bavinton BR. Sustaining sexual and reproductive health through COVID-19 pandemic restrictions: qualitative interviews with Australian clinicians. Sex Health 2022; 19:525-532. [PMID: 36038359 DOI: 10.1071/sh22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The sexual and reproductive health care of people with HIV and those at risk of HIV has largely been delivered face-to-face in Australia. These services adapted to the coronavirus disease 2019 (COVID-19) pandemic with a commitment to continued care despite major impacts on existing models and processes. Limited attention has been paid to understanding the perspectives of the sexual and reproductive health care workforce in the research on COVID-19 adaptations. METHODS Semi-structured interviews were conducted between June and September 2021 with 15 key informants representing a diverse range of service settings and professional roles in the Australian sexual and reproductive health sector. Inductive themes were generated through a process of reflexive thematic analysis, informed by our deductive interest in clinical adaptations. RESULTS The major adaptations were: triage (rapidly adapting service models to protect the most essential forms of care); teamwork (working together to overcome ongoing threats to service quality and staff wellbeing), and the intwined themes of telehealth and trust (remaining connected to marginalised communities through remote care). Despite impacts on care models and client relationships, there were sustained benefits from the scaleup of remote care, and attention to service safety, teamwork and communication. CONCLUSIONS Attending to the experiences of those who worked at the frontline of the COVID-19 response provides essential insights to inform sustained, meaningful system reform over time. The coming years will provide important evidence of longer-term impacts of COVID-19 interruptions on both the users and providers of sexual and reproductive health services.
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Affiliation(s)
- Christy E Newman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Doug Fraser
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic. 3004, Australia
| | - Christopher Bourne
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia; and Sydney Sexual Health Centre, Sydney, NSW 2000, Australia; and Centre for Population Health, NSW Health, St Leonards, NSW 2065, Australia
| | - Andrew E Grulich
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Benjamin R Bavinton
- The Kirby Institute, Wallace Wurth Building, UNSW Sydney, Sydney, NSW 2052, Australia
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25
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Philpot SP, Aung E, Templeton DJ, Stackpool G, Varma R, Power C, Robinson S, Stratigos A, Mao L, Grulich AE, Bavinton BR. Experiences of recently HIV-diagnosed gay and bisexual migrants in Australia: Implications for sexual health programmes and health promotion. Health Soc Care Community 2022; 30:e5801-e5810. [PMID: 36107017 PMCID: PMC10087732 DOI: 10.1111/hsc.14011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/22/2022] [Accepted: 08/20/2022] [Indexed: 05/24/2023]
Abstract
Gay and bisexual migrants from low- and middle-income countries living in high-income countries are disproportionately diagnosed with HIV. Most research focuses on preventing HIV acquisition among HIV-negative migrant gay and bisexual men (GBM). This study is uniquely positioned to report on migrant GBM's experiences and needs at and after an HIV diagnosis. Semi-structured interviews were conducted with 24 migrant GBM diagnosed at sexual health clinics in Australia from 2017 onwards. Interviews were analysed using a codebook thematic analysis. Due to the stigma of HIV and homosexuality in their countries of origin, about half of participants had poor HIV knowledge prior to diagnosis. Absorbing diagnosis information was consequently difficult, and feelings of shame, hopelessness, lost sexual opportunities and infectiousness were common. However, many were thankful for the comprehensive clinical support they received and believed that over time life would 'normalise' with sustained undetectable viral load. None reported that their clinician stigmatised them, but the anticipation of stigma nonetheless infused their experiences after diagnosis. Many were selective about HIV disclosure, and some mentioned that clinic systems posed a risk to confidentiality. Non-permanent residents were concerned about the impacts of HIV status on future visa applications. We recommend that newly HIV-diagnosed migrant GBM receive referral to legal and culturally appropriate migration services to help absorb what a diagnosis might mean for their health and visa status. We also recommend sexual health clinics continue to assess confidentiality in their systems. Health promotion initiatives should highlight to migrant GBM that high-HIV caseload sexual health clinicians provide confidential and comprehensive care.
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Affiliation(s)
| | - Eithandee Aung
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - David J. Templeton
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Department of Sexual Health Medicine and Sexual Assault Medical ServicesSydney Local Health DistrictSydneyAustralia
- Discipline of Medicine, Faculty of Medicine and Health, Central Clinical SchoolThe University of SydneySydneyAustralia
| | - Gai Stackpool
- Multicultural HIV and Hepatitis ServiceDiversity Programs and Strategy Hub, Population Health, Sydney Local Health DistrictSydneyAustralia
| | - Rick Varma
- Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Sydney Sexual Health Centre, Population and Community HealthSouth Eastern Sydney Local Health DistrictSydneyAustralia
| | | | - Sharon Robinson
- Department of Infectious Diseases, Immunology and Sexual HealthSt George HospitalSydneyAustralia
- St George and Sutherland Clinical SchoolUNSW SydneySydneyNew South WalesAustralia
| | | | - Limin Mao
- Centre for Social Research in HealthUNSW SydneyNew South WalesSydneyAustralia
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26
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Wulandari LPL, He SY, Fairley CK, Bavinton BR, Marie-Schmidt H, Wiseman V, Guy R, Tang W, Zhang L, Ong JJ. Preferences for pre-exposure prophylaxis for HIV: A systematic review of discrete choice experiments. EClinicalMedicine 2022; 51:101507. [PMID: 35844771 PMCID: PMC9284393 DOI: 10.1016/j.eclinm.2022.101507] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We aimed to systematically review the health preference literature using discrete choice experiments (DCEs), an attribute-based stated preference method, to investigate patient preferences for HIV pre-exposure prophylaxis (PrEP). METHODS A search in PubMed, Scopus, CINAHL, and Embase was conducted on July 1, 2021, and updated on November 3, 2021. We used two concepts to create our search strategy: (1) discrete choice experiments/conjoint analysis/best-worst scaling, and (2) HIV PrEP.The study is registered in PROSPERO (CRD42021267026). FINDINGS In total, 1060 studies were identified, and 18 were included in the analysis. Various attributes were examined, including dosing regimen, type of PrEP products, side effects, other side benefits, cost, effectiveness, dispensing venue, and additional support services. Dosing frequency, cost, the effectiveness of PrEP, dispensing venue, and side effects were the most common attributes examined in DCEs. Despite significant heterogeneity in preferences across subpopulations, overall, the most important attributes were cost (28%, 5/18), effectiveness (28%, 5/18) followed by dosing frequency (17%, 3/18). INTERPRETATION Notably, in studies where all of these three attributes were examined, some individuals would trade effectiveness for cost or vice versa. Ensuring PrEP is low cost or free, widely disseminating information of its effectiveness and advancements in reducing dosing frequency could accelerate the uptake of PrEP for those who would benefit from PrEP the most. FUNDING None.
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Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Faculty of Medicine, Udayana University, Bali Indonesia
| | - Shi Yi He
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | | | - Heather Marie-Schmidt
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
- Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Weiming Tang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
- Corresponding author at: China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China.
| | - Jason J. Ong
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street London, London, United Kingdom
- Corresponding author at: 580 Swanston Street, Carlton, Victoria 3053, Australia.
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27
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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. Arch Sex Behav 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] [What about the content of this article? (0)] [Affiliation(s)] [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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28
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Philpot SP, Murphy D, Chan C, Haire B, Fraser D, Grulich AE, Bavinton BR. Switching to Non-daily Pre-exposure Prophylaxis Among Gay and Bisexual Men in Australia: Implications for Improving Knowledge, Safety, and Uptake. Sex Res Social Policy 2022; 19:1979-1988. [PMID: 35730059 DOI: 10.1007/s13178-021-00669-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) dosing options such as event-driven PrEP hold promise to increase PrEP uptake among gay, bisexual, and queer men (GBQM), but their impacts have not yet been realized and uptake by GBQM suitable for PrEP remains slow in countries where it is only considered an alternative option to daily PrEP. METHODS We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBQM in Australia to understand PrEP dosing behaviors, knowledge, and preferences. RESULTS All participants commenced PrEP daily; 35% had ever switched to non-daily PrEP, mostly taking it event-driven. GBQM who preferred non-daily PrEP had infrequent or predictable sex, were concerned about cost given infrequency of sex, and/or wanted to minimize unnecessary drug exposure. Accurate knowledge of event-driven PrEP was poor. However, reflecting concepts underpinning critical pedagogy, having accurate knowledge was supported by access to consistent messaging across clinical, social, community, and public settings. Several participants who switched to event-driven PrEP had condomless sex events in which they were unable to adhere to pills due to unanticipated sex. CONCLUSIONS AND POLICY IMPLICATIONS Implementation of comprehensive and consistent education about correct dosing for event-driven PrEP across multiple settings is needed to ensure increased uptake and safe use. GBQM require messaging about non-condom based HIV prevention strategies when they cannot access daily or event-driven PrEP.
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Affiliation(s)
| | - Dean Murphy
- The Kirby Institute, UNSW, Sydney, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW, Sydney, Australia
| | | | - Doug Fraser
- The Kirby Institute, UNSW, Sydney, Australia
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29
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Chan C, Vaccher S, Fraser D, Grulich AE, Holt M, Zablotska-Manos I, Prestage GP, Bavinton BR. Incorrect Knowledge of Event-Driven PrEP "2-1-1" Dosing Regimen Among PrEP-Experienced Gay and Bisexual Men in Australia. J Acquir Immune Defic Syndr 2022; 90:132-139. [PMID: 35135976 DOI: 10.1097/qai.0000000000002935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Event-driven pre-exposure prophylaxis (ED-PrEP), when taken according to the "2-1-1" dosing method, is highly effective at preventing HIV acquisition for gay, bisexual, and other men who have sex with men (GBM). Any missed doses when using ED-PrEP drastically reduce its effectiveness, so it is vital that people using this method know how to take it correctly. This study investigated Australian GBM's awareness of ED-PrEP and their knowledge of how to take it correctly. METHOD We conducted a survey of 1471 PrEP-experienced GBM in Australia, between October 2019 and March 2020. The survey assessed awareness and knowledge of the 3 components of the "2-1-1" ED-PrEP dosing regimen (number of pills for loading dose, timing of loading dose, and number of days after sex to take PrEP pills) among GBM. Characteristics associated with ED-PrEP awareness and correct knowledge of how to take ED-PrEP were assessed with multivariate logistic regression. RESULTS Two-thirds (n = 1004, 68.4%) had heard of ED-PrEP, of whom only one-eighth (n = 125, 12.5%) knew the correct details of the "2-1-1" ED-PrEP method; one-third (n = 339, 33.8%) did not know any of the 3 key components. Awareness of ED-PrEP and correct knowledge was associated with greater belief in PrEP efficacy, university education, and intention to take a nondaily PrEP regimen in the next 6 months. CONCLUSIONS Although ED-PrEP awareness was considerable, most participants did not know how to use ED-PrEP correctly. Further work is needed to increase awareness and knowledge of ED-PrEP among GBM.
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Affiliation(s)
- Curtis Chan
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Doug Fraser
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Martin Holt
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia ; and
| | - Iryna Zablotska-Manos
- Sydney Medical School, Westmead and Western Sydney Sexual Health Centre, University of Sydney, Sydney, Australia
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Storer D, Prestage G, McManus H, Maher L, Bavinton BR, Ellard J, Jin F, Philpot S, Holt M, Saxton P, Haire B, Murphy D, Hammoud MA. Relationship Between Sexual Behaviors with Non-committed Relationship Partners and COVID-19 Restrictions and Notification Rates: Results from a Longitudinal Study of Gay and Bisexual Men in Australia. Sex Res Social Policy 2022; 20:825-836. [PMID: 35669626 PMCID: PMC9142826 DOI: 10.1007/s13178-022-00733-8] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 05/28/2023]
Abstract
Introduction COVID-19 related lockdowns have impacted the sexual activity of gay and bisexual men (GBM). We investigated trends in sexual behaviors and the COVID-19 context in which they occurred (COVID-notification rates and jurisdictional restrictions) to understand changes in the duration and severity of periods of lockdown on the sexual behavior of Australian GBM. Methods In an online, prospective observational study of 831 GBM from May 2020 to May 2021, we investigated associations between changes in sexual behavior among Australian GBM, lockdowns, and COVID-19 notification rates through weekly surveys from May 2020 to May 2021. Results The mean age was 45.71 years (SD: 13.93). Most identified as gay (89.0%) and 10.2% were living with HIV. There was an overall increase in the mean weekly number of non-committed relationship partners (0.53-0.90, p < 0.001). The state of Victoria experienced a significant extended COVID-19 outbreak, accompanied by severe lockdown restrictions. In response, Victorian men's partner numbers shifted three times, while elsewhere there was an overall gradually increasing trend. Conclusions Less severe outbreaks with shorter lockdown periods, involving fewer and geographically contained, COVID-19 notifications were accompanied by non-significant changes in sex with non-relationship partners than more severe outbreaks over extended periods and larger geographical areas. Supplementary Information The online version contains supplementary material available at 10.1007/s13178-022-00733-8.
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Affiliation(s)
- Daniel Storer
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Garrett Prestage
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Hamish McManus
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Lisa Maher
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | | | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Steven Philpot
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Peter Saxton
- Department of Social and Community Health, University of Auckland, Auckland, New Zealand
| | - Bridget Haire
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Dean Murphy
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Mohamed A. Hammoud
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
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Zhang Y, Wiseman V, Applegate TL, Lourenco RDA, Street DJ, Smith K, Jamil MS, Terris-Prestholt F, Fairley CK, McNulty A, Hynes A, Johnson K, Chow EPF, Bavinton BR, Grulich A, Stoove M, Holt M, Kaldor J, Guy R, Ong JJ. Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia. Front Med (Lausanne) 2022; 9:839479. [PMID: 35514755 PMCID: PMC9063480 DOI: 10.3389/fmed.2022.839479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/16/2022] [Indexed: 01/13/2023] Open
Abstract
Background In Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM. Methods Preferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences. Findings We recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution. Interpretation Our findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,*Correspondence: Ye Zhang
| | - Virginia Wiseman
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya L. Applegate
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah J. Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsty Smith
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Muhammad S. Jamil
- Global Human immunodeficiency virus (HIV), Hepatitis and Sexually transmitted infections (STIs) Programmes, World Health Organization, Geneva, Switzerland
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K. Fairley
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia,School of Population Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Adam Hynes
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Eric P. F. Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin R. Bavinton
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Andrew Grulich
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | | | - Martin Holt
- Centre for Social Research in Health, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - John Kaldor
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Rebecca Guy
- Kirby Institute, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Jason J. Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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32
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Nakiganda LJ, Bavinton BR, Grulich AE, Serwadda D, Nakubulwa R, Poynten IM, Bell S. Social Influences on Engagement With HIV Testing, Treatment and Care Services Among Men Who Have Sex With Men Living in Rural Uganda. Qual Health Res 2022; 32:635-645. [PMID: 34923882 DOI: 10.1177/10497323211058162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Men who have sex with men in Uganda are a heterogenous, discriminated population, experiencing high HIV burden, limited access to HIV testing, and low treatment adherence. We contribute to the lack of information about men who have sex with men in rural Uganda by using socio-ecological analyses to examine the social influences shaping their engagement with HIV services. Based on in-depth interviews with 16 men, our findings reveal the inhibitive influence of interpersonal relationships with sexual partners, peers and families, and institutional influences within health service and non-governmental organizational settings. Yet men take action to strategize and seek support to enhance engagement with HIV care in heavily criminalized and stigmatized settings. Future HIV prevention, testing, treatment, and care responses could draw on what affected individuals and communities are already doing to enhance access to HIV services and the effective support strategies of some non-governmental organizations and healthcare workers.
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Affiliation(s)
- Lydia J Nakiganda
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Benjamin R Bavinton
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Andrew E Grulich
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - David Serwadda
- 561068Rakai Health Sciences Program, Kalisizo, Uganda
- 58589Makerere University School of Public Health, Kampala, Uganda
| | | | - Isobel M Poynten
- Kirby Institute for Infection and Immunity in Society, 7800UNSW Sydney, Sydney, NSW, Australia
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, 1974The University of Queensland, Saint Lucia, QLD, Australia
- School of Public Health, 1974The University of Queensland, Saint Lucia, QLD, Australia
- Centre for Social Research in Health, 7800UNSW Sydney, Sydney, NSW, 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: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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. Arch Sex Behav 2022; 51:355-364. [PMID: 35039984 PMCID: PMC8763302 DOI: 10.1007/s10508-021-02276-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Philpot SP, Murphy D, Chan C, Haire B, Fraser D, Grulich AE, Bavinton BR. Switching to Non-daily Pre-exposure Prophylaxis Among Gay and Bisexual Men in Australia: Implications for Improving Knowledge, Safety, and Uptake. Sex Res Social Policy 2022; 19:1979-1988. [PMID: 35730059 PMCID: PMC9203261 DOI: 10.1007/s13178-022-00736-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) dosing options such as event-driven PrEP hold promise to increase PrEP uptake among gay, bisexual, and queer men (GBQM), but their impacts have not yet been realized and uptake by GBQM suitable for PrEP remains slow in countries where it is only considered an alternative option to daily PrEP. METHODS We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBQM in Australia to understand PrEP dosing behaviors, knowledge, and preferences. RESULTS All participants commenced PrEP daily; 35% had ever switched to non-daily PrEP, mostly taking it event-driven. GBQM who preferred non-daily PrEP had infrequent or predictable sex, were concerned about cost given infrequency of sex, and/or wanted to minimize unnecessary drug exposure. Accurate knowledge of event-driven PrEP was poor. However, reflecting concepts underpinning critical pedagogy, having accurate knowledge was supported by access to consistent messaging across clinical, social, community, and public settings. Several participants who switched to event-driven PrEP had condomless sex events in which they were unable to adhere to pills due to unanticipated sex. CONCLUSIONS AND POLICY IMPLICATIONS Implementation of comprehensive and consistent education about correct dosing for event-driven PrEP across multiple settings is needed to ensure increased uptake and safe use. GBQM require messaging about non-condom based HIV prevention strategies when they cannot access daily or event-driven PrEP.
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Affiliation(s)
| | - Dean Murphy
- The Kirby Institute, UNSW, Sydney, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW, Sydney, Australia
| | | | - Doug Fraser
- The Kirby Institute, UNSW, Sydney, Australia
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Chan C, Vaccher S, Fraser D, Grulich AE, Holt M, Zablotska-Manos I, Prestage GP, Bavinton BR. Preferences for Current and Future PrEP Modalities Among PrEP-Experienced Gay and Bisexual Men in Australia. AIDS Behav 2022; 26:88-95. [PMID: 34142274 DOI: 10.1007/s10461-021-03344-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 01/02/2023]
Abstract
Alternatives to daily dosing of HIV pre-exposure prophylaxis (PrEP) are continuing to emerge. From October 2019 to March 2020, we conducted an online survey of PrEP-experienced gay and bisexual men in Australia about interest in and preference for four different PrEP modalities: daily dosing, event-driven dosing, long-acting injectable (LAI)-PrEP and subdermal PrEP implants. Using data from 1477 participants, we measured interest and preference of different modalities using multivariate logistic regression. High proportions of participants were interested in LAI-PrEP (59.7%), daily PrEP (52.0%), PrEP implants (45.3%) and event-driven PrEP (42.8%). LAI-PrEP was the most frequently selected preference (30.5%), followed by PrEP implants (26.3%), daily PrEP (21.4%) and event-driven PrEP (21.2%). Higher interest and preference for non-daily PrEP modalities were associated with being concerned about side effects and perceived difficulties with daily adherence. As novel modalities emerge, attitudes to them should be considered in public health messaging to facilitate informed decision-making.
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Affiliation(s)
- Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Martin Holt
- The Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Iryna Zablotska-Manos
- Sydney Medical School - Westmead and Western Sydney Sexual Health Centre, University of Sydney, Sydney, Australia
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Chan C, Fraser D, Vaccher S, Yeung B, Jin F, Amin J, Dharan NJ, Carr A, Ooi C, Vaughan M, Holden J, Power C, Grulich AE, Bavinton BR. Overcoming barriers to HIV pre-exposure prophylaxis (PrEP) coverage in Australia among Medicare-ineligible people at risk of HIV: results from the MI-EPIC clinical trial. Sex Health 2021; 18:453-459. [PMID: 34895427 DOI: 10.1071/sh21096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
Background Overseas-born people who are ineligible for government-subsidised health care experience barriers to accessing HIV pre-exposure prophylaxis (PrEP) in Australia. This study aimed to assess a program providing free PrEP to overseas-born adults at risk of acquiring HIV. Methods Medicare-Ineligible Expanded Implementation in Communities (MI-EPIC) was a single-arm, open-label trial of daily tenofovir disoproxil fumarate/emtricitabine as PrEP. Six clinics recruited Medicare-ineligible adults who met HIV risk criteria in New South Wales, Australia. We recorded data on HIV and sexually transmitted infection (STI) diagnoses, and PrEP dispensing from July 2019 to June 2020. PrEP adherence as a medication possession ratio (MPR) was calculated as pills dispensed divided by days. We administered an optional survey on behaviours and attitudes to PrEP and sexual health. Results The 221 participants (206 men; 93.2%) had a median age of 29years (IQR 26-34). Participants were mostly born in Asia (53.4%), Latin America or the Caribbean (25.3%), or Europe (10.9%). Adherence was high; 190 participants (86.0%) had an MPR of >60%. Of 121 survey participants, 42 (34.7%) completed the survey in a language other than English. Of participants who had not used PrEP in the 6months before enrolment (n=45, 37.2%), the most common reasons were cost (n=22, 48.9%), and lack of knowledge about accessing PrEP (n=20, 44.4%). Conclusions Medicare-ineligible people at risk of HIV demonstrate high adherence when given access to free PrEP and translated information. Increasing PrEP awareness and reducing barriers to accessing PrEP in this high-risk population should be priorities in HIV prevention.
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Affiliation(s)
- Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Barbara Yeung
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Department of Health Systems and Populations, Macquarie University, North Ryde, NSW, Australia
| | - Nila J Dharan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Andrew Carr
- St Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | | | | | - Jo Holden
- NSW Ministry of Health, Sydney, NSW, Australia
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Philpot SP, Holt M, Murphy D, Haire B, Prestage G, Maher L, Bavinton BR, Hammoud MA, Jin F, Bourne A. Qualitative Findings on the Impact of COVID-19 Restrictions on Australian Gay and Bisexual Men: Community Belonging and Mental Well-being. Qual Health Res 2021; 31:2414-2425. [PMID: 34433350 DOI: 10.1177/10497323211039204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
COVID-19 may threaten the already poor mental health outcomes of Australian gay and bisexual men and cut ties to important social/sexual networks and community. Qualitative research into the experiences of gay and bisexual men during COVID-19 regulations is currently sparse. We report on 489 responses to a qualitative free-text question asking Australian gay and bisexual men about the impacts of COVID-19 during April 2020. Issues pertinent to gay and bisexual men include lost ties to gay and bisexual social/sexual communities, spaces, and activities, which can reduce a sense of belonging to important sexual identity spaces, as well as significant mental well-being vulnerabilities. Reminiscing the collective response to HIV/AIDS, findings reinforce the value of gay and bisexual community organizations, spaces, and networks as supports for gay and bisexual men and emphasize the need for delivering mental health services.
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Affiliation(s)
| | - Martin Holt
- UNSW Sydney, Kensington, New South Wales, Australia
| | - Dean Murphy
- UNSW Sydney, Kensington, New South Wales, Australia
| | | | | | - Lisa Maher
- UNSW Sydney, Kensington, New South Wales, Australia
| | | | | | - Fengyi Jin
- UNSW Sydney, Kensington, New South Wales, Australia
| | - Adam Bourne
- La Trobe University, Bundoora, Victoria, Australia
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Bavinton BR, Hammoud MA, Holt M, Saxton P, Bourne A, MacGibbon J, Jin F, Maher L, Prestage GP. Changes in Sexual Behaviour Following PrEP Initiation Among Australian Gay and Bisexual Men in Relationships: Results from a Prospective Observational Study. AIDS Behav 2021; 25:3704-3711. [PMID: 33782881 DOI: 10.1007/s10461-021-03232-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Few studies have examined changes in sexual behaviour following HIV pre-exposure prophylaxis (PrEP) initiation among gay, bisexual and other men who have sex with men (GBM) in relationships. In a national, online, prospective study of GBM in Australia, we compared sexual behaviours prior to and after PrEP initiation among HIV-negative and unknown-HIV-status men (recruited 2014-2017) not taking PrEP at baseline and who completed at least one six-monthly follow-up by July 2018. Among men in relationships who did not initiate PrEP (n = 339), we compared their most recent survey to their prior one, while among men in relationships who initiated PrEP (n = 81), we compared follow-ups before and after PrEP initiation. Among the 81 PrEP-initiators who were in a relationship both before and after initiation, the proportion reporting their regular partner was on PrEP increased from 8.3 to 44.4% (p < 0.001) and the proportion reporting receptive CLAIC increased from 27.2 to 44.4% (p = 0.009). Overall, men who initiated PrEP were more likely to be in a relationship with a partner on PrEP, and it appeared they started PrEP around the same time. Receptive CLAIC also became more common.
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Zhang Y, Jamil MS, Smith KS, Applegate TL, Prestage G, Holt M, Keen P, Bavinton BR, Chen M, Conway DP, Wand H, McNulty AM, Russell D, Vaughan M, Batrouney C, Wiseman V, Fairley CK, Grulich AE, Law M, Kaldor JM, Guy RJ. The longer-term effects of access to HIV self-tests on HIV testing frequency in high-risk gay and bisexual men: follow-up data from a randomised controlled trial. Lancet Reg Health West Pac 2021; 14:100214. [PMID: 34671752 PMCID: PMC8484892 DOI: 10.1016/j.lanwpc.2021.100214] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/31/2021] [Accepted: 06/29/2021] [Indexed: 11/02/2022]
Abstract
Background A wait-list randomised controlled trial in Australia (FORTH) in high-risk gay and bisexual men (GBM) showed access to free HIV self-tests (HIVSTs) doubled the frequency of HIV testing in year 1 to reach guideline recommended levels of 4 tests per year, compared to two tests per year in the standard-care arm (facility-based testing). In year 2, men in both arms had access to HIVSTs. We assessed if the effect was maintained for a further 12 months. Methods Participants included GBM reporting condomless anal intercourse or > 5 male partners in the past 3 months. We included men who had completed at least one survey in both year 1 and 2 and calculated the mean tests per person, based on the validated self-report and clinic records. We used Poisson regression and random effects Poisson regression models to compare the overall testing frequency by study arm, year and testing modality (HIVST/facility-based test). Findings Overall, 362 men completed at least one survey in year 1 and 343 in year 2. Among men in the intervention arm (access to HIVSTs in both years), the mean number of HIV tests in year 2 (3⋅7 overall, 2⋅3 facility-based tests, 1⋅4 HIVSTs) was lower compared to year 1 (4⋅1 overall, 1⋅7 facility-based tests, 2⋅4 HIVSTs) (RR:0⋅84, 95% CI:0⋅75-0⋅95, p=0⋅002), but higher than the standard-care arm in year 1 (2⋅0 overall, RR:1⋅71, 95% CI:1⋅48-1.97, p<0⋅001). Findings were not different when stratified by sociodemographic characteristics or recent high risk sexual history. Interpretation In year 2, fewer HIVSTs were used on average compared to year 1, but access to free HIVSTs enabled more men to maintain higher HIV testing frequency, compared with facility-based testing only. HIV self-testing should be a key component of HIV testing and prevention strategies. Funding This work was supported by grant 568971 from the National Health and Medical Research Council of Australia.
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Affiliation(s)
- Ye Zhang
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Phillip Keen
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Handan Wand
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Anna M McNulty
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns North, QLD, Australia.,James Cook University, Townsville, QLD, Australia
| | | | | | - Virginia Wiseman
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Matthew Law
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - John M Kaldor
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Rebecca J Guy
- Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Hill AO, Bavinton BR, Kaneko N, Lafferty L, Lyons A, Gilmour S, Armstrong G. Associations Between Social Capital and HIV Risk-Taking Behaviors Among Men Who Have Sex with Men in Japan. Arch Sex Behav 2021; 50:3103-3113. [PMID: 34618277 DOI: 10.1007/s10508-021-02097-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 04/24/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
Social capital has been positively associated with reduced HIV risk. However, few studies have investigated if associations vary between men who have sex with men (MSM) or heterosexual alters (possessors of actual resources embedded within social capital networks) and HIV risk-taking behaviors. In a cross-sectional survey of 1564 MSM in Greater Tokyo, we investigated whether social capital ascertained from MSM or heterosexual alters influenced HIV risk-taking behaviors (i.e., consistent condom use and lifetime HIV testing). Multiple logistic regression revealed that MSM with high levels of social capital from heterosexual networks were twice as likely to report consistent condom use with casual male partners, while MSM who reported high levels of social capital from MSM networks were over twice as likely to have tested for HIV yet were half as likely to use condoms consistently with regular male partners. Associations between MSM, social capital, and HIV testing indicate the potential for integrating social capital enhancement programs into current HIV interventions.
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Affiliation(s)
- Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VC, 3086, Australia.
| | | | - Noriyo Kaneko
- School of Nursing, Nagoya City University, Nagoya, Japan
| | - Lise Lafferty
- Kirby Institute, University of New South Wales, Sydney, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VC, 3086, Australia
| | - Stuart Gilmour
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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42
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Chan C, Patel P, Johnson K, Vaughan M, Price K, McNulty A, Templeton DJ, Read P, Cunningham P, Grulich AE, Bavinton BR. Community-based peer-led HIV/sexually transmitted infection testing services in Sydney for gay and bisexual men captured an eighth of new HIV diagnoses in New South Wales, Australia. AIDS 2021; 35:1878-1880. [PMID: 34397488 DOI: 10.1097/qad.0000000000002982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital
- School of Population Health, UNSW Sydney
| | - David J Templeton
- Kirby Institute, UNSW Sydney
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District
- Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney
| | - Phillip Read
- Kirby Institute, UNSW Sydney
- Kirketon Road Centre
| | - Philip Cunningham
- NSW State Reference Laboratory for HIV, St Vincent's Hospital
- St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia
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43
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Parsons MS, Kristensen AB, Selva KJ, Lee WS, Amarasena T, Esterbauer R, Wheatley AK, Bavinton BR, Kelleher AD, Grulich AE, Khoury G, Juno JA, Kent SJ. Protective efficacy of the anti-HIV broadly neutralizing antibody PGT121 in the context of semen exposure. EBioMedicine 2021; 70:103518. [PMID: 34385004 PMCID: PMC8361295 DOI: 10.1016/j.ebiom.2021.103518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND HIV-1 infections occur following viral exposure at anogenital mucosal surfaces in the presence of semen. Semen contains immunosuppressive and pro-inflammatory factors. Semen from HIV-1-infected donors contains anti-HIV-1 antibodies. We assessed if passively infused anti-HIV-1 neutralizing antibody conferred protection from rectal SHIVSF162P3 challenge at semen exposed mucosae. METHODS We pooled seminal plasma from HIV-1-infected donors. The pool was screened by ELISA for antibodies against HIV-1SF162 gp140. The ability of seminal plasma to inhibit macaque NK cells from responding to direct and antibody-dependent stimulation was assessed. The ability of seminal plasma to inhibit macaque granulocytes from mediating oxidative burst was also assessed. To demonstrate viral infectivity in the presence of seminal plasma, macaques (n = 4) were rectally challenged with SHIVSF162P3 following exposure to 2.5 mL of seminal plasma. To evaluate if anti-HIV-1 neutralizing antibody confers protection against rectal SHIV challenge at semen exposed mucosae, eight macaques were intravenously infused with PGT121, either wild type (n = 4) or the Fc receptor binding deficient LALA variant (n = 4), and rectally challenged with SHIVSF162P3 following exposure to 2.5 mL of seminal plasma. FINDINGS Anti-HIV-1SF162 gp140 antibodies were detected in seminal plasma. Seminal plasma inhibited direct and antibody-dependent NK cell activation and granulocyte oxidative burst in vitro. Rectal SHIVSF162P3 challenge of control macaques following seminal plasma exposure resulted in infection of all animals. All macaques infused with wild type or LALA PGT121 and challenged with SHIVSF162P3 following seminal plasma exposure were protected. INTERPRETATION PGT121 conferred protection against rectal SHIVSF162P3 challenge at semen exposed mucosae. Future research should investigate if semen alters protection conferred by antibodies more dependent on non-neutralizing functions. FUNDING This work was supported by a grant from the Australian National Health and Medical Research Council (APP1124680).
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Affiliation(s)
- Matthew S Parsons
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia; Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA; Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Anne B Kristensen
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin J Selva
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Wen Shi Lee
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Thakshila Amarasena
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Robyn Esterbauer
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Adam K Wheatley
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin R Bavinton
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony D Kelleher
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew E Grulich
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Georges Khoury
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia; Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Jennifer A Juno
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia; ARC Centre for Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Parkville, Victoria, Australia; Melbourne Sexual Health Centre and Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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44
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Nakiganda LJ, Bell S, Grulich AE, Serwadda D, Nakubulwa R, Poynten IM, Bavinton BR. Understanding and managing HIV infection risk among men who have sex with men in rural Uganda: a qualitative study. BMC Public Health 2021; 21:1309. [PMID: 34218799 PMCID: PMC8254907 DOI: 10.1186/s12889-021-11365-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/18/2020] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background Same-sex sexual relations are criminalised in Uganda, and men who have sex with men (MSM) experience a high burden of HIV infection. In Uganda, health promotion policies focus on equity in healthcare and creating enabling environments. At present there is limited evidence upon which to enhance engagement of MSM in rural settings into effective HIV prevention. To fill this gap, our study explored MSM’s understandings of HIV risk and strategies used to reduce HIV risk in their sexual lives. Methods In-depth interviews were conducted with sixteen MSM in rural communities in Southwestern Uganda. Inductive thematic analysis examined men’s perceptions of HIV risk and strategies of reducing their own HIV risks. Results Understandings of HIV risk and risk practices were framed by lack of access to condoms, challenges negotiating condom and pre-exposure prophylaxis (PrEP) use, and condomless sex being reported as more pleasurable than sex with condoms. Strategies men perceived as enabling them to manage HIV risk included: PrEP use; condom use; knowing partners’ HIV status; avoiding partners associated with HIV risk; oral sex; withdrawal before ejaculation and washing one’s penis after sex. There were several misconceptions arising from poor HIV prevention knowledge. Strategies reliant on communication and negotiation with sexual partners were inhibited by gendered powered imbalances. Conclusions Our findings illustrate that MSM in rural settings in Uganda are making concerted efforts to implement strategies that might reduce risk of HIV transmission and infection within their sexual relationships. Key HIV health promotion and service-related strategies to support MSM with these efforts include an effective condom and lubricant supply chain; a PrEP program in trusted local health units, implemented via discreet community-outreach mechanisms; and same-sex specific HIV-related health promotion.
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Affiliation(s)
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia.,Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | | | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda.,Makerere University School of Public Health, Kampala, Uganda
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45
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Grulich AE, Jin F, Bavinton BR, Yeung B, Hammoud MA, Amin J, Cabrera G, Clackett S, Ogilvie E, Vaccher S, Vickers T, McNulty A, Smith DJ, Dharan NJ, Selvey C, Power C, Price K, Zablotska I, Baker DA, Bloch M, Brown K, Carmody CJ, Carr A, Chanisheff D, Doong N, Finlayson R, Lewis DA, Lusk J, Martin S, Ooi C, Read P, Ryder N, Smith D, Tuck Meng Soo C, Templeton DJ, Vlahakis E, Guy R. Long-term protection from HIV infection with oral HIV pre-exposure prophylaxis in gay and bisexual men: findings from the expanded and extended EPIC-NSW prospective implementation study. Lancet HIV 2021; 8:e486-e494. [PMID: 34217426 DOI: 10.1016/s2352-3018(21)00074-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Daily pre-exposure prophylaxis (PrEP) is effective in preventing HIV, but few long-term data are available on effectiveness and adherence in real-world settings. Here, we report trends in HIV incidence over 3 years in individuals at high risk who were prescribed PrEP in New South Wales (NSW), as well as adherence before the transition to subsidised PrEP. METHODS Expanded PrEP Implementation in Communities-New South Wales (EPIC-NSW) was a pragmatic, prospective, single-arm, implementation study of daily, oral PrEP in 31 sites (sexual health clinics, general practices, and a hospital) in NSW, Australia. Eligible participants were HIV-negative adults (aged ≥18 years) who were at high risk of HIV infection as defined in local PrEP guidelines. Participants were prescribed coformulated (once-daily, oral tablet) tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP and were followed up with HIV testing, sexually transmitted infection testing, and PrEP dispensing. Originally planned for 3700 participants followed for 1 year, the study was expanded so that all eligible participants in the state could obtain PrEP and extended until publicly subsidised PrEP became available in Australia. The primary outcome was new HIV infection among all participants who were dispensed PrEP at least once and had at least one follow-up HIV test result. Adherence was estimated by medication possession ratio (MPR), defined as the proportion of PrEP pills dispensed in 90 days, assuming daily dosing. This study is registered with ClinicalTrials.gov, NCT02870790. FINDINGS Between March 1, 2016, and April 30, 2018, we enrolled 9709 participants. 9596 participants were dispensed PrEP, of whom 9448 (98·3%) were gay or bisexual men. Participants were followed up until March 31, 2019, with at least one follow-up HIV test available in 9520 (99·2%) participants. Mean MPR declined from 0·93 to 0·64 from the first to the ninth quarter. There were 30 HIV seroconversions over 18 628 person-years, an incidence of 1·61 per 1000 person-years (95% CI 1·13-2·30). Being younger, living in a postcode with fewer gay men, reporting more risk behaviours at baseline, and having an MPR of less than 0·6 were each univariately associated with increased HIV incidence. In the final year of follow-up, when PrEP was mostly purchased rather than provided free by the study, HIV incidence remained low at 2·24 per 1000 person-years (1·46-3·44). INTERPRETATION HIV incidence remained low over up to 3 years of follow-up, including during a transition from study-provided to publicly subsidised PrEP. In a setting of affordable PrEP and associated health-care services, very low HIV incidence of 1 to 2 per 1000 person-years can be maintained in gay and bisexual men who were previously at high risk. FUNDING New South Wales Ministry of Health, Australian Capital Territory Health Directorate, Gilead Sciences.
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Affiliation(s)
- Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Barbara Yeung
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mohamed A Hammoud
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Janaki Amin
- Department of Health Systems and Populations, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gesalit Cabrera
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Shawn Clackett
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; New South Wales Ministry of Health, Sydney, NSW, Australia
| | - Erin Ogilvie
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Stefanie Vaccher
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Tobias Vickers
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - David J Smith
- North Coast HIV/Sexual Health Services, Lismore, NSW, Australia
| | - Nila J Dharan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Cherie Power
- New South Wales Ministry of Health, Sydney, NSW, Australia
| | | | - Iryna Zablotska
- Western Sydney Sexual Health Centre and Sydney Medical School Westmead, University of Sydney, Sydney, NSW, Australia
| | | | - Mark Bloch
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Holdsworth House Medical Practice, Darlinghurst, NSW, Australia
| | | | | | - Andrew Carr
- St Vincent's Hospital, Darlinghurst, NSW, Australia
| | | | | | | | - David A Lewis
- Western Sydney Sexual Health Centre and Sydney Medical School Westmead, University of Sydney, Sydney, NSW, Australia; Marie Bashir Institute for Biosecurity and Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | - Josephine Lusk
- Short Street Clinic, Kogorah, St George Hospital, NSW, Australia
| | - Sarah Martin
- Canberra Sexual Health Centre, Canberra Health Services, Canberra Hospital, Canberra, ACT, Australia
| | | | - Phillip Read
- Kirketon Road Centre, Kings Cross, NSW, Australia
| | - Nathan Ryder
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Hunter-New England Sexual Health, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Don Smith
- The Albion Centre, Surry Hills, NSW, Australia
| | - Clara Tuck Meng Soo
- Hobart Place General Practice and East Canberra General Practice, ACT, Australia
| | - David J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Discipline of Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District Camperdown, NSW, Australia
| | | | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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46
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Bavinton BR, Grulich AE. HIV pre-exposure prophylaxis: scaling up for impact now and in the future. Lancet Public Health 2021; 6:e528-e533. [PMID: 34087117 DOI: 10.1016/s2468-2667(21)00112-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022]
Abstract
More than a decade after the first efficacy evidence for oral HIV pre-exposure prophylaxis (PrEP) was reported, PrEP uptake globally has been inadequate and global HIV prevention targets have been missed. Access to PrEP is still highly concentrated in a fairly small number of countries and, even within countries with widespread PrEP access, inequalities have emerged. More ambitious, high-priority global targets for PrEP uptake are required and could accelerate the HIV prevention response in a similar way to the success of the 90-90-90 testing and treatment targets. Health systems must be PrEP-friendly and allow PrEP to be prescribed in settings already attended by large numbers of HIV-negative individuals who are at risk. Several models have been advanced for the greater demedicalisation of PrEP. Individual-level barriers to PrEP uptake and persistence have been characterised, such as low awareness, low willingness to use PrEP, and the gap between self-perceived and actual HIV risk. Overcoming these barriers will require further efforts to understand and address them first. New PrEP modalities are emerging; as more options become available, we need to develop a greater understanding of the long-term patterns of PrEP use in different populations and to develop models of such use that can accommodate people alternating through periods of use and non-use, as well as switching between dosing regimens or modalities as they become available. Scaling up PrEP is crucial to achieving the UNAIDS prevention targets for 2030. Simply getting more people onto PrEP cannot be the only goal: the big-picture definition of success for PrEP programmes must be their impact on the HIV epidemic.
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Affiliation(s)
| | - Andrew E Grulich
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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47
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Patel PG, Keen P, McManus H, Duck T, Callander D, Selvey C, Power C, Gray RT, Knight V, Asselin J, Read P, Johnson K, Bavinton BR, Bowden VJ, Grulich AE, Guy R. Increased targeted HIV testing and reduced undiagnosed HIV infections among gay and bisexual men. HIV Med 2021; 22:605-616. [PMID: 33876526 DOI: 10.1111/hiv.13102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/13/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the impact of government HIV strategies that aimed to increase HIV testing uptake and frequency among gay and bisexual men (GBM) in New South Wales (NSW), Australia. DESIGN We analysed HIV testing data from existing passive and sentinel surveillance systems between 2010 and 2018. METHODS Six indicators were measured: (1) state-wide total HIV laboratory tests; (2) number of GBM attending publicly-funded clinics; (3) 12-monthly testing uptake; (4) annual testing frequency; (5) HIV testing with a STI diagnosis; and (6) HIV positivity. Mathematical modelling was used to estimate (7) the proportion of men with undiagnosed HIV. Indicators were stratified by Australian vs. overseas-born. RESULTS Overall, 43,560 GBM attended participating clinics (22,662 Australian-born, 20,834 overseas-born) from 2010-2018. Attendees increased from 5,186 in 2010 to 16,507 in 2018. There were increasing trends (p<0.001 for all) in testing uptake (83.9% to 95.1%); testing with a STI diagnosis (68.7% to 94.0%); annual HIV testing frequency (1.4 to 2.7); and a decreasing trend (p<0.01) in HIV positivity (1.7% to 0.9%).Increases in testing were similar in Australian-born and overseas-born GBM. However, there were decreasing trends in the estimated undiagnosed HIV proportion overall (9.5% to 7.7%) and in Australian-born GBM (7.1% to 2.8%), but an increasing trend in overseas-born GBM (15.3% to 16.9%) (p<0.001 for all).
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Affiliation(s)
- P G Patel
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - P Keen
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - H McManus
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - T Duck
- New South Wales Ministry of Health, Sydney, NSW, Australia
| | - D Callander
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,New York University Spatial Epidemiology Lab, School of Medicine, New York University, New York, NY, USA
| | - C Selvey
- Health Protection NSW, Sydney, Australia
| | - C Power
- New South Wales Ministry of Health, Sydney, NSW, Australia
| | - R T Gray
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - V Knight
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - J Asselin
- Burnet Institute, Melbourne, NSW, Australia
| | - P Read
- Kirketon Road Centre, Kings Cross, NSW, Australia
| | | | - B R Bavinton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - V J Bowden
- Health Protection NSW, Sydney, Australia
| | - A E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - R Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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48
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Holt M, Broady TR, Mao L, Chan C, Rule J, Ellard J, O'Donnell D, Grulich AE, Prestage G, Bavinton BR. Increasing preexposure prophylaxis use and 'net prevention coverage' in behavioural surveillance of Australian gay and bisexual men. AIDS 2021; 35:835-840. [PMID: 33587442 DOI: 10.1097/qad.0000000000002797] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess trends in HIV prevention strategies among Australian gay and bisexual men (GBM) since the introduction of preexposure prophylaxis (PrEP), the level of net prevention coverage (the use of safe strategies), and the characteristics of HIV-negative and untested GBM who remain at risk of HIV. DESIGN Repeated behavioural surveillance of GBM recruited from venues, events and online in seven Australian states and territories. METHODS Participants with casual male partners were included. Trends in sexual practices, prevention strategies, net prevention coverage and the characteristics of 'at risk' participants were assessed with binary and multivariate logistic regression. RESULTS A total of 32 048 survey responses (2014-2019) were included. The proportion of participants who reported consistent condom use declined (44.6-23.2%). The proportion who reported any condomless anal intercourse with casual partners increased (37.4-62.0%) but net prevention coverage also increased (68.1-74.9%), with higher levels of undetectable viral load among HIV-positive participants and rapidly increasing PrEP use by HIV-negative participants. PrEP became the most commonly reported prevention strategy in 2019 (31.1%). The analysis of 'at risk' participants showed that they became more likely to report frequent condomless anal intercourse with casual partners but had fewer partners and more partners with undetectable viral load or on PrEP. 'At risk' participants became more likely to identify as bisexual and to be born overseas. CONCLUSION There has been a rapid, historic shift in HIV prevention among GBM in Australia. Net prevention coverage has increased among GBM and 'at risk' GBM have become less at risk of HIV, facilitating reductions in HIV transmission.
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Affiliation(s)
| | | | - Limin Mao
- Centre for Social Research in Health
| | | | - John Rule
- National Association of People With HIV Australia
| | - Jeanne Ellard
- Australian Federation of AIDS Organisations, Sydney, New South Wales, Australia
| | - Darryl O'Donnell
- The Kirby Institute, UNSW Sydney
- Australian Federation of AIDS Organisations, Sydney, New South Wales, Australia
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Di Giallonardo F, Pinto AN, Keen P, Shaik A, Carrera A, Salem H, Selvey C, Nigro SJ, Fraser N, Price K, Holden J, Lee FJ, Dwyer DE, Bavinton BR, Geoghegan JL, Grulich AE, Kelleher AD. Subtype-specific differences in transmission cluster dynamics of HIV-1 B and CRF01_AE in New South Wales, Australia. J Int AIDS Soc 2021; 24:e25655. [PMID: 33474833 PMCID: PMC7817915 DOI: 10.1002/jia2.25655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/27/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The human immunodeficiency virus 1 (HIV-1) pandemic is characterized by numerous distinct sub-epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses. METHODS We used HIV-1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV-1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01_AE (CRF01_AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01_AE sequences sampled between 2004 and 2018 in combination with global sequence data and NSW-specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi-Square statistics. RESULTS We identified 104 subtype B and 11 CRF01_AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01_AE respectively. We observed a > 2-fold increase in the number of NSW-specific CRF01_AE clades over time. Subtype B clusters were associated with individuals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection (p < 0.01). CRF01_AE infections clusters were associated with infections among individuals diagnosed during the early stage of infection (p < 0.05) and CRF01_AE singletons were more likely to be from infections among individuals reporting heterosexual transmission (p < 0.05). We found six subtype B clusters with an above-average growth rate (>1.5 sequences / 6-months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01_AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01_AE clusters that contained a large gap in time (>1 year) between infections and may be indicative of intermediate transmissions via undiagnosed individuals. CONCLUSIONS The large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01_AE.
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Affiliation(s)
| | - Angie N Pinto
- The Kirby InstituteThe University of New South WalesSydneyNSWAustralia
- Royal Prince Alfred HospitalSydneyNSWAustralia
| | - Phillip Keen
- The Kirby InstituteThe University of New South WalesSydneyNSWAustralia
| | - Ansari Shaik
- The Kirby InstituteThe University of New South WalesSydneyNSWAustralia
| | | | - Hanan Salem
- New South Wales Health Pathology‐RPARoyal Prince Alfred HospitalCamperdownNSWAustralia
| | | | | | - Neil Fraser
- Positive Life New South WalesSydneyNSWAustralia
| | | | | | - Frederick J Lee
- New South Wales Health Pathology‐RPARoyal Prince Alfred HospitalCamperdownNSWAustralia
- Sydney Medical SchoolUniversity of SydneySydneyNSWAustralia
| | - Dominic E Dwyer
- New South Wales Health Pathology‐ICPMRWestmead HospitalWestmeadNSWAustralia
| | | | - Jemma L Geoghegan
- Department of Microbiology and ImmunologyUniversity of OtagoDunedinNew Zealand
- Institute of Environmental Science and ResearchWellingtonNew Zealand
| | - Andrew E Grulich
- The Kirby InstituteThe University of New South WalesSydneyNSWAustralia
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50
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Di Giallonardo F, Pinto AN, Keen P, Shaik A, Carrera A, Salem H, Selvey C, Nigro SJ, Fraser N, Price K, Holden J, Lee FJ, Dwyer DE, Bavinton BR, Grulich AE, Kelleher AD, On Behalf Of The Nsw Hiv Prevention Partnership Project. Increased HIV Subtype Diversity Reflecting Demographic Changes in the HIV Epidemic in New South Wales, Australia. Viruses 2020; 12:E1402. [PMID: 33291330 PMCID: PMC7762219 DOI: 10.3390/v12121402] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022] Open
Abstract
Changes over time in HIV-1 subtype diversity within a population reflect changes in factors influencing the development of local epidemics. Here we report on the genetic diversity of 2364 reverse transcriptase sequences from people living with HIV-1 in New South Wales (NSW) notified between 2004 and 2018. These data represent >70% of all new HIV-1 notifications in the state over this period. Phylogenetic analysis was performed to identify subtype-specific transmission clusters. Subtype B and non-B infections differed across all demographics analysed (p < 0.001). We found a strong positive association for infections among females, individuals not born in Australia or reporting heterosexual transmission being of non-B origin. Further, we found an overall increase in non-B infections among men who have sex with men from 50 to 79% in the last 10 years. However, we also found differences between non-B subtypes; heterosexual transmission was positively associated with subtype C only. In addition, the majority of subtype B infections were associated with clusters, while the majority of non-B infections were singletons. However, we found seven non-B clusters (≥5 sequences) indicative of local ongoing transmission. In conclusion, we present how the HIV-1 epidemic has changed over time in NSW, becoming more heterogeneous with distinct subtype-specific demographic associations.
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Affiliation(s)
| | - Angie N Pinto
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
- Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Phillip Keen
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
| | - Ansari Shaik
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
| | - Alex Carrera
- HIV Reference Laboratory, Sydney 2010, Australia
| | - Hanan Salem
- New South Wales Health Pathology-RPA, Royal Prince Alfred Hospital, Camperdown 2050, Australia
| | | | | | - Neil Fraser
- Positive Life New South Wales, Sydney 2010, Australia
| | - Karen Price
- AIDS Council of NSW (ACON), Sydney 2010, Australia
| | | | - Frederick J Lee
- New South Wales Health Pathology-RPA, Royal Prince Alfred Hospital, Camperdown 2050, Australia
- Sydney Medical School, University of Sydney, Sydney 2050, Australia
| | - Dominic E Dwyer
- New South Wales Health Pathology-ICPMR, Westmead Hospital, Westmead 2145, Australia
| | - Benjamin R Bavinton
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
| | - Anthony D Kelleher
- The Kirby Institute, The University of New South Wales, Sydney 2052, Australia
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