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Zablotska IB. Likely impact of pre-exposure prophylaxis on HIV epidemics among men who have sex with men. Sex Health 2019; 14:97-105. [PMID: 27883309 DOI: 10.1071/sh16153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/20/2016] [Indexed: 12/23/2022]
Abstract
Rapid developments in the field of HIV pre-exposure prophylaxis (PrEP) with antiretrovirals offer a promise to bring HIV transmission among gay and other men who have sex with men (MSM) to zero by 2030. This review evaluates studies, which modelled the impact of PrEP on HIV diagnoses, and discusses the progress towards PrEP implementation. Studies in English, conducted after 2010 among MSM in countries of the Organization for Economic Cooperation and Development (OECD) were reviewed. Six modelling studies were included, three of which had been conducted outside the US. None of the published models showed that PrEP alone can reduce HIV diagnoses to zero and eliminate HIV transmission by 2030. However, PrEP in combination with other biomedical interventions can reduce HIV diagnoses on the population level by ~95%. Other upcoming biomedical prevention strategies may strengthen combination prevention. Access to PrEP remains limited, even in the OECD countries. Modelling studies can assist governments with decision-making about PrEP implementation and add urgency to the implementation of PrEP. More work is needed on modelling of the impact of PrEP on HIV diagnoses trends outside the US where PrEP implementation is in its early stages.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia. Email
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Bavinton BR, Grulich AE, Duncan D, Zablotska IB, Prestage GP. How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men. Sex Health 2019. [PMID: 28637581 DOI: 10.1071/sh16198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Regular sexual partnerships among gay and bisexual men (GBM) who practice condomless anal intercourse (CLAI) have not been well characterised in terms of partnership type, HIV seroconcordance and risk of HIV transmission. Primarily sexual regular partnerships, although commonly reported by gay men, have largely been ignored in research and HIV prevention. Among regular partners reporting CLAI with each other, we determined factors differentiating romantic or committed relationships from partnerships organised primarily around sex ('fuckbuddies') and estimated the proportion of CLAI presenting risk for HIV transmission. METHODS An online, cross-sectional survey of Australian GBM was conducted. Univariate and multivariate generalised estimating equations were used to determine statistical associations. RESULTS Men reported on 2250 regular sexual partnerships. Over half the partnerships were romantic or committed relationships. Over half the partnerships were HIV-negative seroconcordant (54.9%), 3.1% were HIV-positive seroconcordant, 5.2% were serodiscordant and 36.8% were of unknown seroconcordance. Potential risks presented by CLAI were sometimes mitigated by protective factors, such as having a clear spoken agreement about sex with outside partners, having fewer outside partners, openly discussing HIV risk and having an agreement to reduce risk from outside partners. These protective factors were more often found in romantic or committed relationships than among primarily sexual partnerships, and were less often found in partnerships of unknown seroconcordance. CONCLUSION CLAI is more common among regular sexual partnerships considered to be of a romantic, committed nature. However, factors associated with such romantic or committed partnerships can also protect against HIV transmission risk. Unknown seroconcordance, particularly lack of communication about HIV status among primarily sexual partnerships, is a key risk factor that needs to be addressed by HIV education.
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Affiliation(s)
| | | | - Duane Duncan
- University of New England, Armidale, NSW 2351, Australia
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Zablotska IB, Vaccher SJ, Bloch M, Carr A, Foster R, Grulich AE, Guy R, McNulty A, Ooi C, Pell C, Poynten IM, Prestage G, Ryder N, Templeton D. High Adherence to HIV Pre-exposure Prophylaxis and No HIV Seroconversions Despite High Levels of Risk Behaviour and STIs: The Australian Demonstration Study PrELUDE. AIDS Behav 2019; 23:1780-1789. [PMID: 30284653 DOI: 10.1007/s10461-018-2290-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PrELUDE study evaluated daily pre-exposure prophylaxis (PrEP) in high-risk individuals in Australia. This open-label, single-arm study tested participants for HIV/STI and collected behavioural information three-monthly. We report trends over 18 months in medication adherence, side-effects, HIV/STI incidence and behaviour. 320 gay/bisexual men (GBM), 4 women and 3 transgender participants, followed on average 461 days, reported taking seven pills/week on 1,591 (88.5%) occasions and 4-6 pills/week on 153 (8.5%) occasions. No HIV infections were observed. STI incidence was high and stable, while gonorrhoea infections declined from 100.0 to 25.8/100 person-years between 6 and 15 months (p < 0.001). The number of HIV-positive and unknown-status sex partners, and condomless anal intercourse, significantly increased. In this high-risk cohort of mainly GBM, increases in risk behaviours and high STI incidence were not accompanied by HIV infections due to high adherence to daily PrEP. The study informed policy and further PrEP implementation among Australian GBM.
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Vaccher SJ, Kaldor JM, Callander D, Zablotska IB, Haire BG. Qualitative Insights Into Adherence to HIV Pre-Exposure Prophylaxis (PrEP) Among Australian Gay and Bisexual Men. AIDS Patient Care STDS 2018. [DOI: 10.1089/apc.2018.0106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
| | | | - Denton Callander
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Iryna B. Zablotska
- Westmead Clinical School, University of Sydney Medical School, Sydney, Australia
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Zablotska IB, Gray R, Whittaker B, Holt M, Wright E, Prestage G, O’Donnell D, Grulich AE. The estimated number of potential PrEP users among gay-identifying men who have sex with men in Australia. PLoS One 2018; 13:e0204138. [PMID: 30335758 PMCID: PMC6193616 DOI: 10.1371/journal.pone.0204138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/03/2018] [Indexed: 11/22/2022] Open
Abstract
We estimated the size of the population of gay-identified men who have sex with men (gay men) eligible for PrEP in Australia under the current national PrEP guidelines. Using input indicators from the Australian Bureau of Statistics, the national representative survey Second Australian Study of Health and Relationships, and national HIV- behavioural surveillance, we calculated the size of the population of sexually active gay men and estimated a range for the number eligible for PrEP using different scenarios based on the guidelines. In 2015, an estimated 108,850 sexually-active 16-69-year-old gay men were classified as at risk of acquiring HIV in Australia. Of these men, 10,558 to 30,913 (9.7%-28.4%) were classified as being at high risk and therefore eligible for PrEP, most commonly due to recent receptive condomless intercourse with casual partners (6.1% to 15.5%), STI infections (5.4% to 10.6%) or the use of crystal methamphetamine (1.4% to 9.4%). The higher estimates included men who may have been at HIV risk for shorter time periods or with fewer partners. Australian PrEP guidelines recommend targeting PrEP to people at high HIV risk. Our estimation of potential PrEP users informed PrEP implementation in Australia. The choice of PrEP eligibility criteria, and interpretation of the guidelines, strongly affects the population estimates. In the future, higher numbers of gay men may become eligible for PrEP, because the estimates are largely defined by and follow trends in condomless anal intercourse. Our estimation methods can be adapted to other settings.
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Affiliation(s)
- Iryna B. Zablotska
- Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Richard Gray
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Bill Whittaker
- National Association of People with HIV, Newtown, New South Wales, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Edwina Wright
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Garrett Prestage
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Darryl O’Donnell
- Australian Federation of AIDS Organisations, Newtown, New South Wales, Australia
| | - Andrew E. Grulich
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW The aim of this study is to summarise the recent evidence from high-income settings about providers' ability to deliver on the UNAIDS goal of at least three million people at substantial risk of HIV infection with PrEP by 2020, including awareness and knowledge about PrEP, willingness to prescribe PrEP, current levels of prescribing and service delivery models and issues. RECENT FINDINGS Awareness about PrEP among health providers is growing, but at different pace depending on provider type. HIV and sexual health specialists are more likely to have knowledge about PrEP than generalists, and to be willing to prescribe it, mainly because of their closer contact with people at high risk for HIV and better risk assessment skills. There is still no consensus as to who should be responsible for providing PrEP, but clearly all hands on deck will be useful in delivering on the international target of three million people at substantial risk for HIV on PrEP by 2020. Only about 5% of the target has been reached so far. Local guidance and large-scale education and information programs for clinicians will be necessary to upskill health providers. High cost of PrEP is still a major barrier for its broad implementation, even in countries were PrEP roll-out has started. Health services are facing major structural challenges due to implementation of PrEP services to a substantial volume of patients. The early implementation experiences demonstrated that PrEP can be successfully delivered across a variety of settings, and a broad range of strategies and models of care can streamline PrEP delivery. Education of the providers and PrEP cost solutions will be essential for rapid roll-out of PrEP.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia.
| | - Catherine C O'Connor
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia
- Sexual Health Service, Sydney Local Health District, Camperdown, 2050, Australia
- Central Clinical School, University of Sydney, Sydney, 2006, Australia
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Zablotska IB, Selvey C, Guy R, Price K, Holden J, Schmidt HM, McNulty A, Smith D, Jin F, Amin J, Cooper DA, Grulich AE. Correction: expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in new South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health 2018; 18:297. [PMID: 29490635 PMCID: PMC5831707 DOI: 10.1186/s12889-018-5173-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
After publication of the article [1], it has been brought to our attention that one of the members of the EPIC-NSW study group has had their name spelt incorrectly in the acknowledgements. The article mentions "Muhammad Hammoud" when in fact the correct spelling is "Mohamed Hammoud".
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
| | | | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Karen Price
- AIDS Council of New South Wales (ACON), Sydney, NSW, Australia
| | - Jo Holden
- NSW Ministry of Health, Sydney, NSW, Australia
| | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - David Smith
- Mid North Coast Local Health District (Area HIV/Sexual Health Services), Lismore Health Service, Lismore, NSW, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.,MacquarieUniversity, Sydney, NSW, Australia
| | - David A Cooper
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
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Zablotska IB, Selvey C, Guy R, Price K, Holden J, Schmidt HM, McNulty A, Smith D, Jin F, Amin J, Cooper DA, Grulich AE. Expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in New South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health 2018; 18:210. [PMID: 29394918 PMCID: PMC5797394 DOI: 10.1186/s12889-017-5018-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [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: 06/30/2017] [Accepted: 12/21/2017] [Indexed: 01/08/2023] Open
Abstract
Background The New South Wales (NSW) HIV Strategy 2016–2020 aims for the virtual elimination of HIV transmission in NSW, Australia, by 2020. Despite high and increasing levels of HIV testing and treatment since 2012, the annual number of HIV diagnoses in NSW has remained generally unchanged. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among gay and bisexual men (GBM) when taken appropriately. However, there have been no population-level studies that evaluate the impact of rapid PrEP scale-up in high-risk GBM. Expanded PrEP Implementation in Communities in NSW (EPIC-NSW) is a population-level evaluation of the rapid, targeted roll-out of PrEP to high-risk individuals. Methods EPIC-NSW, is an open-label, single-arm, multi-centre prospective observational study of PrEP implementation and impact. Over 20 public and private clinics across urban and regional areas in NSW have participated in the rapid roll-out of PrEP, supported by strong community mobilization and PrEP promotion. The study began on 1 March 2016, aiming to enroll at least 3700 HIV negative people at high risk of HIV. This estimate took into consideration criteria for PrEP prescription in people at high risk for acquiring HIV as defined in the NSW PrEP guidelines. Study participants receive once daily co-formulated tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and are followed for up to 24 months. Follow-up includes: testing for HIV at 1 month, HIV and other sexually transmissible infections three-monthly, HCV annually and monitoring of renal function six-monthly. Optional online behavioural surveys are conducted quarterly. The co-primary endpoints are (i) HIV diagnoses and incidence in the cohort and (ii) HIV diagnoses in NSW. Discussion EPIC-NSW is a population-based PrEP implementation trial which targets the entire estimated population of GBM at high risk for HIV infection in NSW. It will provide a unique opportunity to evaluate the population impact of PrEP on a concentrated HIV epidemic. Trial registration https://clinicaltrials.gov/ (identifying number NCT02870790; registration date 14 August 2016), pre-results stage. Electronic supplementary material The online version of this article (10.1186/s12889-017-5018-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
| | | | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Karen Price
- AIDS Council of New South Wales (ACON), Sydney, NSW, Australia
| | - Jo Holden
- NSW Ministry of Health, Sydney, NSW, Australia
| | | | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - David Smith
- Mid North Coast Local Health District (Area HIV/Sexual Health Services), Lismore Health Service, Lismore, NSW, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.,Macquarie University, Sydney, NSW, Australia
| | - David A Cooper
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, 2052, Australia.
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Zablotska IB, Baeten JM, Phanuphak N, McCormack S, Ong J. Getting pre-exposure prophylaxis (PrEP) to the people: opportunities, challenges and examples of successful health service models of PrEP implementation. Sex Health 2018; 15:481-484. [DOI: 10.1071/sh18182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 11/23/2022]
Abstract
Pre-exposure prophylaxis (PrEP) with antiretrovirals could prevent millions of infections, yet effective strategies to get PrEP delivered are just being defined. This editorial introduces a series of 17 articles which form a special issue of Sexual Health focused on the opportunities and challenges for health service providers engaged in PrEP prescribing. All pieces presented here share useful lessons from PrEP pioneers; more than that, they should serve as catalysts to accelerate PrEP implementation around the world.
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Vaccher SJ, Gianacas C, Templeton DJ, Poynten IM, Haire BG, Ooi C, Foster R, McNulty A, Grulich AE, Zablotska IB. Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project. Front Public Health 2017; 5:341. [PMID: 29326917 PMCID: PMC5736869 DOI: 10.3389/fpubh.2017.00341] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/30/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction The effectiveness of daily pre-exposure prophylaxis (PrEP) is well established. However, there has been increasing interest in non-daily dosing schedules among gay and bisexual men (GBM). This paper explores preferences for PrEP dosing schedules among GBM at baseline in the PRELUDE demonstration project. Materials and methods Individuals at high-risk of HIV were enrolled in a free PrEP demonstration project in New South Wales, Australia, between November 2014 and April 2016. At baseline, they completed an online survey containing detailed behavioural, demographic, and attitudinal questions, including their ideal way to take PrEP: daily (one pill taken every day), event-driven (pills taken only around specific risk events), or periodic (daily dosing during periods of increased risk). Results Overall, 315 GBM (98% of study sample) provided a preferred PrEP dosing schedule at baseline. One-third of GBM expressed a preference for non-daily PrEP dosing: 20% for event-driven PrEP, and 14% for periodic PrEP. Individuals with a trade/vocational qualification were more likely to prefer periodic to daily PrEP [adjusted odds ratio (aOR) = 4.58, 95% confidence intervals (95% CI): (1.68, 12.49)], compared to individuals whose highest level of education was high school. Having an HIV-positive main regular partner was associated with strong preference for daily, compared to event-driven PrEP [aOR = 0.20, 95% CI: (0.04, 0.87)]. Participants who rated themselves better at taking medications were more likely to prefer daily over periodic PrEP [aOR = 0.39, 95% CI: (0.20, 0.76)]. Discussion Individuals’ preferences for PrEP schedules are associated with demographic and behavioural factors that may impact on their ability to access health services and information about PrEP and patterns of HIV risk. At the time of data collection, there were limited data available about the efficacy of non-daily PrEP schedules, and clinicians only recommended daily PrEP to study participants. Further research investigating how behaviours and PrEP preferences change correspondingly over time is needed. Trial registration ClinicalTrials.gov NCT02206555. Registered 28 July 2014.
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Affiliation(s)
| | | | - David J Templeton
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,RPA Sexual Health, Sydney Local Health District and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Catriona Ooi
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Rosalind Foster
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Clinic 16 Northern Sydney Sexual Health, Royal North Shore Community Health Centre, St Leonards, NSW, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia.,School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
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Vaccher SJ, Grulich AE, Haire BG, Conway DP, Poynten IM, Ooi C, Foster R, Templeton DJ, Zablotska IB. Validation of participant eligibility for pre-exposure prophylaxis: Baseline data from the PRELUDE demonstration project. PLoS One 2017; 12:e0185398. [PMID: 28950022 PMCID: PMC5614574 DOI: 10.1371/journal.pone.0185398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/10/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In Australia, pre-exposure prophylaxis (PrEP) is targeted to individuals at high risk for HIV infection. We describe the HIV risk profile and characteristics of PRELUDE participants, and evaluate the population validity of the sample in representing high-risk gay and bisexual men (GBM) eligible for PrEP. METHODS PRELUDE is an on-going, open-label, single-arm observational study. Participants were identified in clinics and screened for eligibility using a paper-based risk assessment tool which followed the New South Wales (NSW) PrEP guidelines. Selection was validated using an independent online behavioural survey, completed by study participants upon enrolment. Demographic information was analysed using descriptive statistics, and kappa tests were used to determine agreement between reporting of high-risk practices in the risk assessment and behavioural survey. RESULTS During 2014-15, 471 individuals were targeted for enrolment; 341 were assessed for PrEP eligibility and 313 were enrolled. Of these, 303 (97%) identified as GBM. Overall, 85% of GBM met at least one high-risk criterion; 68% reported receptive intercourse with an HIV-positive or unknown status casual male partner, and 37% reported methamphetamine use in the three months preceding enrolment. The remaining 15% were enrolled based on medium-risk behaviours, or at the clinicians' discretion. We found an 82% total agreement between self-reported high-risk behaviour and clinicians' categorisation of GBM as being at high risk for HIV based on PrEP eligibility criteria. CONCLUSIONS Behavioural eligibility criteria used by clinicians successfully identified individuals at high risk for HIV infection. This targeted approach ensures that the greatest public health and HIV prevention benefits can be derived in a setting without universal access to PrEP.
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Affiliation(s)
- Stefanie J. Vaccher
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- * E-mail: (SJV); (IBZ)
| | - Andrew E. Grulich
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Bridget G. Haire
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Damian P. Conway
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Isobel M. Poynten
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Catriona Ooi
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia
| | - Rosalind Foster
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- Clinic 16, Northern Sydney Sexual Health, St Leonards, New South Wales, Australia
| | - David J. Templeton
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- RPA Sexual Health, Sydney Local Health District and Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Iryna B. Zablotska
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- * E-mail: (SJV); (IBZ)
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Moore CL, Gidding HF, Jin F, Mao L, Petoumenos K, Zablotska IB, Poynten IM, Prestage G, Law MG, Grulich AE, Amin J. Patterns of Drug Use and Drug-related Hospital Admissions in HIV-Positive and -Negative Gay and Bisexual Men. AIDS Behav 2016; 20:2372-2386. [PMID: 26837635 DOI: 10.1007/s10461-016-1303-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 11/30/2022]
Abstract
We aimed to compare rates of illicit drug-related hospitalisations in HIV-negative (HIV-ve) (n = 1325) and HIV-positive (HIV+ve) (n = 557) gay and bisexual men (GBM) with rates seen in the general male population and to examine the association between self-reported illicit drug use and drug-related hospitalisation. Participants were asked how often they used a range of illicit drugs in the previous 6 months at annual interviews. Drug-related hospital admissions were defined as hospital admissions for mental or behavioural disorders due to illicit drug use (ICD 10: F11-16, F18, F19), drug poisoning (T40-T45, T50) or toxic effect of gases (T53, T59, T65). Drug-related hospitalisations were 4.8 times higher in the HIV-ve cohort [SIR 4.75 (95 % CI 3.30-6.91)] and 3.5 times higher in the HIV+ve cohort [SIR 3.51 (1.92-5.88)] compared with the general population. Periods of weekly drug use [IRR 1.86 (1.01-3.46)], poly-drug use [IRR 2.17 (1.07-4.38)] and cannabis use [low use-IRR 1.95 (1.01-3.77), high use-IRR 2.58 (1.29-5.16)] were associated with drug-related hospitalisation in both cohorts, as was being a consistently high meth/amphetamine user throughout follow-up [IRR 3.24 (1.07-9.83)] and being an inconsistent or consistent injecting drug user throughout follow-up [IRR 3.94 (1.61-9.66), IRR 4.43(1.04-18.76), respectively]. Other risk factors for drug-related hospitalisation indicated the likelihood of comorbid drug and mental health issues in GBM hospitalised for drug use.
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Affiliation(s)
- Cecilia L Moore
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Heather F Gidding
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - I Mary Poynten
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Matthew G Law
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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Bavinton BR, Duncan D, Grierson J, Zablotska IB, Down IA, Grulich AE, Prestage GP. The Meaning of 'Regular Partner' in HIV Research Among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey. AIDS Behav 2016; 20:1777-84. [PMID: 26971284 DOI: 10.1007/s10461-016-1354-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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] [Indexed: 11/29/2022]
Abstract
Estimates of the proportion of HIV infections coming from within regular sexual relationships among gay and bisexual men (GBM) vary widely. Research surveys use various partner type categories, but there is little understanding of how men classify their partners. We conducted an online cross-sectional survey of Australian GBM exploring sexual relationships, including 2057 men reporting on 2566 regular partnerships. Just over half of the partnerships were considered 'relationships', while the remainder were non-romantic 'fuckbuddy'-style arrangements. In multivariable analysis, factors associated with considering the partnership a 'relationship' were: using a 'romantic' descriptor, partnership length, monogamous agreements, any condomless anal sex with each other, love, and commitment. The category of 'regular partner' can mask diverse partnership types, which have different meanings to GBM, associated behaviours, and HIV risks. Certain HIV prevention techniques may be more suited to particular types of partnerships. 'Fuckbuddy' arrangements need to be more explicitly acknowledged in HIV prevention.
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Affiliation(s)
- Benjamin R Bavinton
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
| | | | | | - Iryna B Zablotska
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ian A Down
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Andrew E Grulich
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Garrett P Prestage
- Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Bavinton BR, Jin F, Prestage G, Zablotska IB, Grinsztejn B, Phanuphak N, Moore R, Koelsch KK, Grulich AE. O20.3 Hiv transmission in male serodiscordant couples in australia, thailand and brazil. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052270.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Moore CL, Grulich AE, Prestage G, Gidding HF, Jin F, Mao L, Petoumenos K, Zablotska IB, Poynten IM, Law MG, Amin J. Hospitalisation rates and associated factors in community-based cohorts of HIV-infected and -uninfected gay and bisexual men. HIV Med 2015; 17:327-39. [PMID: 26344061 DOI: 10.1111/hiv.12312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES There is evidence that HIV-positive patients are suffering from a greater burden of morbidity as they age due to nonAIDS-related complications. To date it has been difficult to determine what part of this excess risk is due to the health effects of HIV, its treatment or to lifestyle factors common to gay and bisexual men (GBM). We calculated overall and cause-specific hospitalisation rates and risk factors for hospitalisations in HIV-negative and HIV-positive cohorts of GBM and compare these with rates in the general male population. METHODS We conducted a record linkage study, linking two cohorts of HIV-negative (n = 1325) and HIV-positive (n = 557) GBM recruited in Sydney, New South Wales (NSW), Australia with the NSW hospital discharge data register. We compared rates of hospitalisation in the two cohorts and risk factors for hospitalisation using random-effects Poisson regression methods. Hospitalisation rates for each cohort were further compared with those in the general male population using indirect standardisation. RESULTS We observed 2032 hospitalisations in the HIV-negative cohort during 13,016 person-years (PYs) [crude rate: 15.6/100 PYs (95% CI: 14.9-16.3)] and 2130 hospitalisations in the HIV-positive cohort during 5571 PYs [crude rate: 38.2/100 PYs (95% CI: 36.6-39.9)]. HIV-positive individuals had an increased risk of hospitalisation compared with the HIV-negative individuals [adjusted-IRR: 2.34 (95% CI: 1.91-2.86)] and the general population [SHR: 1.45 (95% CI: 1.33-1.59)]. Hospitalisation rates were lower in the HIV-negative cohort compared with the general population [SHR: 0.72 (95% CI: 0.67-0.78)]. The primary causes of hospitalisation differed between groups. CONCLUSIONS HIV-positive GBM continue to experience excess morbidity compared with HIV-negative GBM men and the general population. HIV-negative GBM had lower morbidity compared with the general male population suggesting that GBM identity does not confer excess risk.
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Affiliation(s)
- C L Moore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - A E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - G Prestage
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic., Australia
| | - H F Gidding
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - F Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - L Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - K Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - I B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - I M Poynten
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M G Law
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - J Amin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Zablotska IB, Frankland A, Holt M, de Wit J, Brown G, Maycock B, Fairley C, Prestage G. Methodological challenges in collecting social and behavioural data regarding the HIV epidemic among gay and other men who have sex with men in Australia. PLoS One 2014; 9:e113167. [PMID: 25409440 PMCID: PMC4237373 DOI: 10.1371/journal.pone.0113167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/20/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Behavioural surveillance and research among gay and other men who have sex with men (GMSM) commonly relies on non-random recruitment approaches. Methodological challenges limit their ability to accurately represent the population of adult GMSM. We compared the social and behavioural profiles of GMSM recruited via venue-based, online, and respondent-driven sampling (RDS) and discussed their utility for behavioural surveillance. METHODS Data from four studies were selected to reflect each recruitment method. We compared demographic characteristics and the prevalence of key indicators including sexual and HIV testing practices obtained from samples recruited through different methods, and population estimates from respondent-driven sampling partition analysis. RESULTS Overall, the socio-demographic profile of GMSM was similar across samples, with some differences observed in age and sexual identification. Men recruited through time-location sampling appeared more connected to the gay community, reported a greater number of sexual partners, but engaged in less unprotected anal intercourse with regular (UAIR) or casual partners (UAIC). The RDS sample overestimated the proportion of HIV-positive men and appeared to recruit men with an overall higher number of sexual partners. A single-website survey recruited a sample with characteristics which differed considerably from the population estimates with regards to age, ethnically diversity and behaviour. Data acquired through time-location sampling underestimated the rates of UAIR and UAIC, while RDS and online sampling both generated samples that underestimated UAIR. Simulated composite samples combining recruits from time-location and multi-website online sampling may produce characteristics more consistent with the population estimates, particularly with regards to sexual practices. CONCLUSION Respondent-driven sampling produced the sample that was most consistent to population estimates, but this methodology is complex and logistically demanding. Time-location and online recruitment are more cost-effective and easier to implement; using these approaches in combination may offer the potential to recruit a more representative sample of GMSM.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, The University of NSW Australia, Sydney, NSW, Australia
| | - Andrew Frankland
- The Kirby Institute, The University of NSW Australia, Sydney, NSW, Australia; School of Psychiatry, The University of NSW Australia, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, The University of NSW Australia, Sydney, NSW, Australia
| | - John de Wit
- Centre for Social Research in Health, The University of NSW Australia, Sydney, NSW, Australia
| | - Graham Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia; Curtin University, Perth, WA, Australia
| | | | - Christopher Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Melbourne, VIC, Australia
| | - Garrett Prestage
- The Kirby Institute, The University of NSW Australia, Sydney, NSW, Australia; The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
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Abstract
We aimed to describe HIV risk practices of gay men who travel locally, regionally and overseas. We analysed data from the Sydney Gay Community Periodic Survey 2009 about high-risk sexual practices in four locations (locally, while travelling in NSW, Australia and overseas) and with partners of HIV positive, negative and unknown serostatus in each location. Analyses of associations used generalized log-binomial estimation procedures with Type I error of 5 %. Of 1,839 sexually active participants, 70.1 % reported having sex locally. 19.7 % elsewhere in NSW, 20.1 % interstate and 18 % overseas. Unprotected anal intercourse (UAI) was reported by 29.9, 28.6, 21.3 and 19.3 % of men in each location respectively. There was no difference in the levels of UAI locally and elsewhere in NSW, but UAI levels were lower in other Australian locations [adjusted prevalence rate ratio (APRR) = 0.76; 95 % confidence interval (95 % CI) 0.66-0.88] and overseas (APRR = 0.76; 95 % CI 0.65-0.89). UAI was more likely if partners were seroconcordant HIV positive (APRR = 1.67; 95 % CI 1.32-2.11) and less likely if partners were of different HIV serostatus (APRR = 0.39; 95 % CI 0.33-0.47) as compared to seroconcordant HIV negative partners. UAI was associated with group sex and use of party drugs. In this community sample, UAI levels were higher in the local context than in travel destinations, suggesting that familiarity between partners may play a role. High-risk sexual practices can nevertheless contribute to bridging different HIV epidemics and HIV transmission across borders. HIV prevention programs should develop effective approaches to target sexually adventurous gay men and HIV transmission associated with travel.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia,
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18
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Yang M, Prestage G, Maycock B, Brown G, de Wit J, McKechnie M, Guy R, Keen P, Fairley CK, Zablotska IB. The acceptability of different HIV testing approaches: cross-sectional study among GMSM in Australia. Sex Transm Infect 2014; 90:592-5. [PMID: 25015651 DOI: 10.1136/sextrans-2013-051495] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We explored the attitudes of Australian gay and other men who have sex with men (GMSM) about the current standard-of-care (non-rapid tests at healthcare settings) and alternative approaches (rapid tests and testing in non-healthcare settings) to better understand the acceptability of alternative testing approaches. METHODS The Contemporary Norms in Networks and Communities of GMSM study enrolled GMSM in Sydney, Melbourne and Perth in 2011-2012 using peer referrals. We explored the self-reported preferences for testing: rapid versus non-rapid and in non-healthcare settings (community-based or home-based testing) versus in healthcare settings, and examined factors associated with preferences for these approaches. Analyses of associations used standard univariate and age-adjusted logistic regression models. RESULTS Among 827 sexually active non-HIV-positive participants, 89% had been tested for HIV. Most preferred by participants was home rapid testing (46%), followed by standard-of-care (23%) and rapid testing in healthcare (20%) or community settings (7%). About 73% of participants preferred rapid over non-rapid testing, and 56% preferred testing in non-healthcare settings rather than in healthcare settings. Preference for rapid testing was associated with being fully employed (adjusted OR (aOR): 1.81; 95% CI 1.16 to 2.82), managerial/professional occupation (aOR: 2.03; 95% CI 1.19 to 3.46) and engaging in unprotected anal intercourse with casual partners (aOR: 1.89; 95% CI 1.29 to 2.78). The same factors were associated with preference for testing in non-healthcare settings. CONCLUSIONS Australian GMSM prefer alternative testing approaches, possibly due to their convenience. The availability of new testing approaches may provide more options for GMSM at risk for HIV infection, improve access to HIV testing and potentially increase HIV testing rates.
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Affiliation(s)
- M Yang
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - G Prestage
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - B Maycock
- Curtin University, Perth, Western Australia, Australia
| | - G Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia Curtin University, Perth, Western Australia, Australia
| | - J de Wit
- Centre for Social Research in Health, The University of NSW Australia, Sydney, New South Wales, Australia
| | - M McKechnie
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - R Guy
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - P Keen
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
| | - C K Fairley
- Melbourne School of Population Health, University of Melbourne, Victoria, Australia Melbourne Sexual Health Centre, Melbourne, Victoria, Australia Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - I B Zablotska
- The Kirby Institute, The University of New South Wales Australia, Sydney, New South Wales, Australia
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Zablotska IB, Whittaker B, de Wit J, Kamarulzaman A, Ananworanich J, Wright E, Poynten IM, Mayer K. Bringing new HIV infections to zero - opportunities and challenges offered by antiretroviral-based prevention in Asia, the Pacific and beyond: An overview of this special issue. Sex Health 2014; 11:97-100. [PMID: 25017549 DOI: 10.1071/sh14071] [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: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 11/23/2022]
Abstract
This editorial to the special issue of Sexual Health on antiretroviral-based prevention of HIV infection is dedicated to showcasing research and practice in this area. It aims to promote debate regarding the potential of new antiretroviral-based prevention approaches and the challenges encountered in moving prevention innovations into the community. This special issue covers the breadth of innovative HIV prevention research, including that undertaken in the fields of epidemiology, clinical research, social and behavioural science, public health and policy analysis, and with special emphasis on Asia and the Pacific region. Most importantly, it provides an indication of how the region is progressing towards embracing new prevention approaches to combat HIV epidemics across the region.
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Affiliation(s)
- Iryna B Zablotska
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| | - Bill Whittaker
- National Association of People with HIV (NAPWA), Sydney, NSW 2042, Australia
| | - John de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur 59990, Malaysia
| | | | - Edwina Wright
- The Alfred Hospital and Burnet Institute, Melbourne, Vic. 3004, Australia
| | - Isobel Mary Poynten
- Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| | - Kenneth Mayer
- Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
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Zablotska IB, Holt M, Prestage G. Changes in gay men's participation in gay community life: implications for HIV surveillance and research. AIDS Behav 2012; 16:669-75. [PMID: 21424273 DOI: 10.1007/s10461-011-9919-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Successful antiretroviral treatments, achievements in gay acceptance and human rights, and internet use have prompted changes in gay socialising which create potential challenges for engaging with gay men for HIV surveillance and research. We used data from the Australian behavioural surveillance and explored (i) the relationship between community engagement and HIV related practices, and (ii) time trends in gay men's engagement with the gay community. Analyses were conducted using log-binomial regression and chi-square test for trend. The proportion of men who socialized mainly with gay men declined and the Internet use to connect with sex partners increased over time. Gay social engagement was associated with HIV positive serostatus, unprotected anal intercourse with regular partners and a high frequency of HIV/STI testing. Our findings indicate a shift in how gay men socialise and find partners. We discuss the challenges for ongoing engagement with gay men for behavioural surveillance and HIV research.
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Zablotska IB, Kippax S, Grulich A, Holt M, Prestage G. Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections. Sex Health 2011; 8:272-9. [PMID: 21851766 DOI: 10.1071/sh10125] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 01/27/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Australian HIV and sexually transmissible infection (STI) behavioural surveillance system (the repeated cross-sectional Gay Community Periodic Surveys, GCPS) has been conducted since 1998 and covers six main Australian jurisdictions. In this paper, we review its history and methodology, and the available indicators, their trends and their use. METHODS We describe the design and history of GCPS. For analyses of indicators, we use Pearson's χ²-test and test for trend where appropriate. RESULTS About 90% of gay men in Australia have been tested for HIV (60% to 70% of men who were not HIV-positive) have been tested as recommended in the preceding 12 months. STI testing levels (≈ 70% in the preceding 12 months) are high, but remain insufficient for STI prevention. In general, unprotected anal intercourse with regular (UAIR) and casual (UAIC) sex partners has increased over time. The prevalence and increasing trends in UAIR were similar across jurisdictions (P-trend <0.01), while trends in UAIC differed across the states: during 2001-08, UAIC declined in NSW (P-trend <0.01) and increased elsewhere (P-trend <0.01). Trends in UAIC were associated with HIV diagnoses. CONCLUSION This review of the design, implementation and findings of the Australian HIV/STI behavioural surveillance highlights important lessons for HIV/STI behavioural surveillance among homosexual men, particularly the need for consistent data collection over time and across jurisdictions. Investment in systematic behavioural surveillance appears to result in a better understanding of the HIV epidemic, the availability of a warning system and a better targeted HIV prevention strategy.
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Affiliation(s)
- Iryna B Zablotska
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2052, Australia.
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Mao L, Kippax SC, Holt M, Prestage GP, Zablotska IB, de Wit JBF. Rates of condom and non-condom-based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction? Sex Transm Infect 2011; 87:489-93. [PMID: 21764890 DOI: 10.1136/sextrans-2011-050041] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Three decades into the HIV epidemic and with the advancement of HIV treatments, condom and non-condom-based anal intercourse among gay men in resource-rich countries needs to be re-assessed. METHODS The proportions of men engaging in a range of anal intercourse practices were estimated from the ongoing cross-sectional Gay Community Periodic Surveys in six states in Australia from 2007 to 2009. Comparisons were made between HIV-negative men, HIV-positive men with an undetectable viral load and those with a detectable viral load. RESULTS Condoms play a key role in gay men's anal intercourse practices: 33.8% of HIV-negative men, 25.1% of HIV-positive men with an undetectable viral load and 22.5% of those with a detectable viral load reported consistent condom use with all male partners in the 6 months before the survey. Among HIV-negative men, the second largest group were men who had unprotected anal intercourse (UAI) only in the context of HIV-negative seroconcordant regular relationships. Among HIV-positive men, the second largest group was men who had UAI in casual encounters preceded by HIV status disclosure to some, but not all, casual partners. CONCLUSIONS A minority, yet sizeable proportion, of men consistently engaged in a number of UAI practices in specific contexts, suggesting they have adopted deliberate HIV risk-reduction strategies. While it is important that HIV behavioural prevention continues to reinforce condom use, it needs to address both the challenges and opportunities of the substantial uptake of non-condom-based risk-reduction strategies.
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Affiliation(s)
- Limin Mao
- National Centre in HIV Social Research, University of New South Wales, Sydney, NSW 2052, Australia.
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Zablotska IB, Crawford J, Imrie J, Prestage G, Jin F, Grulich A, Kippax S. Increases in unprotected anal intercourse with serodiscordant casual partners among HIV-negative gay men in Sydney. AIDS Behav 2009; 13:638-44. [PMID: 19085098 DOI: 10.1007/s10461-008-9506-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [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: 05/20/2008] [Accepted: 12/01/2008] [Indexed: 11/30/2022]
Abstract
Prevalence of unprotected anal intercourse between casual male partners (UAIC) has been increasing worldwide. We explored trends in serodiscordant UAIC and the associated factors among gay men in Sydney. Proportions of HIV-positive and negative men with serodiscordant casual partners increased during 2003-2006. Prevalence of serodiscordant UAIC increased among HIV-negative men. Age, number of partners, seeking partners online, drug use and esoteric practices were associated with serodiscordant UAIC. Increases in serodiscordant UAIC may be related to growing disclosure. These findings do not indicate a core group of high-risk men. More research is needed about the context in which serodiscordant UAIC happens.
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Affiliation(s)
- Iryna B Zablotska
- National Centre in HIV Social Research, University of New South Wales, Sydney, NSW 2052, Australia.
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Zablotska IB, Imrie J, Prestage G, Crawford J, Rawstorne P, Grulich A, Jin F, Kippax S. Gay men's current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing? AIDS Care 2009; 21:501-10. [DOI: 10.1080/09540120802270292] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Iryna B. Zablotska
- a National Centre in HIV Social Research, University of New South Wales , Sydney , Australia
| | - John Imrie
- a National Centre in HIV Social Research, University of New South Wales , Sydney , Australia
| | - Garrett Prestage
- b National Centre in HIV Epidemiology and Clinical Research, University of New South Wales , Sydney , Australia
| | - June Crawford
- a National Centre in HIV Social Research, University of New South Wales , Sydney , Australia
| | - Patrick Rawstorne
- a National Centre in HIV Social Research, University of New South Wales , Sydney , Australia
| | - Andrew Grulich
- b National Centre in HIV Epidemiology and Clinical Research, University of New South Wales , Sydney , Australia
| | - Fengyi Jin
- b National Centre in HIV Epidemiology and Clinical Research, University of New South Wales , Sydney , Australia
| | - Susan Kippax
- a National Centre in HIV Social Research, University of New South Wales , Sydney , Australia
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Zablotska IB, Gray RH, Koenig MA, Serwadda D, Nalugoda F, Kigozi G, Sewankambo N, Lutalo T, Wabwire Mangen F, Wawer M. Alcohol use, intimate partner violence, sexual coercion and HIV among women aged 15-24 in Rakai, Uganda. AIDS Behav 2009; 13:225-33. [PMID: 18064556 DOI: 10.1007/s10461-007-9333-5] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [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: 05/20/2007] [Accepted: 11/05/2007] [Indexed: 11/24/2022]
Abstract
Disinhibition due to alcohol may induce intimate partner violence and sexual coercion and increased risk of HIV infection. In a sample of 3,422 women aged 15-24 from the Rakai cohort, Uganda, we examined the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past and prevalent HIV, using adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI). During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06-1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25-2.56). Alcohol use before sex was associated with physical violence and sexual coercion, and both are jointly associated with HIV infection risk in young women.
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Affiliation(s)
- Iryna B Zablotska
- National Centre in HIV Social Research, University of New South Wales, Sydney 2052, Australia.
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Zablotska IB, Imrie J, Bourne C, Grulich AE, Frankland A, Prestage G. Improvements in sexual health testing among gay men in Sydney, Australia, 2003–2007. Int J STD AIDS 2008; 19:758-60. [DOI: 10.1258/ijsa.2008.008193] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In order to be effective, sexually transmitted infection (STI) testing should be comprehensive based on the clients' sexuality and risk practices. Using data from the Sydney Gay Community Periodic Survey, we explored trends in and factors associated with STI testing among gay men during 2003–2007. Among men who were not HIV-positive, 68% were tested for HIV in 2007. HIV testing was more common than STI testing and remained stable during 2003–2007. Use of swabs and urine samples increased significantly ( P-trend < 0.001 for each). However, until 2007, 33% of men were not tested. Sexual behaviours (higher number of partners, having casual partners and engaging in unprotected anal intercourse with them) were associated with STI testing. HIV-negative men were tested for STI less often than HIV-positive men (prevalence ratio = 0.56; 95% CI: 0.47–0.68). STI testing among HIV-negative men has improved significantly but remains inadequate for STI control and HIV prevention. It should not be assumed that appropriate and comprehensive STI screening is always provided to clients.
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Affiliation(s)
- I B Zablotska
- National Centre in HIV Social Research, University of New South Wales
| | - J Imrie
- National Centre in HIV Social Research, University of New South Wales
| | - C Bourne
- New South Wales STI Programs Unit, Sydney Sexual Health Centre, Sydney and Sydney Eye Hospital
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - A E Grulich
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales
| | - A Frankland
- National Centre in HIV Social Research, University of New South Wales
| | - G Prestage
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales
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Prestage G, Jin F, Zablotska IB, Imrie J, Grulich AE, Pitts M. Trends in HIV testing among homosexual and bisexual men in eastern Australian states. Sex Health 2008; 5:119-23. [PMID: 18588776 DOI: 10.1071/sh07081] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We examined whether trends in HIV testing in community-based samples of homosexual men may account for the convergence in HIV notification rates in homosexual men across the eastern states of Australia. METHODS We examined data on self-reported HIV testing from annual cross-sectional, self-completed anonymous surveys of homosexual men conducted between 1998 and 2006 in Sydney, Melbourne and Brisbane. Men were recruited at gay community venues and events. Comparisons of HIV testing between the three cities and across time were carried out. We also compared reported rates of HIV testing across states in Private Lives, the 2005 online survey of health and wellbeing among non-heterosexual people. RESULTS Men recruited from clinics had a much higher prevalence of HIV testing and were excluded from further analyses. Among the 48 263 completed questionnaires obtained in non-clinic sites, there was a marked decline in the proportion of men who had never been tested for HIV in Sydney (from 8.1 to 5.1%, P trend < 0.001) and Brisbane (from 11.8 to 7.9%, P trend = 0.002) but no change in Melbourne. This proportion of men who had never been tested was lower in Sydney than in either Melbourne or Brisbane (P < 0.001). There were increases in the proportion of non-HIV-positive men who had been tested for HIV in the previous year across all three cities, although the proportion in Melbourne was lower than in the other two cities. CONCLUSION These data suggest that changes in HIV testing rates among homosexual men are insufficient to account for the recent differences in trends in HIV notifications in eastern Australia.
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Affiliation(s)
- Garrett Prestage
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2052, Australia.
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Zablotska IB, Prestage G, Grulich AE, Imrie J. Differing trends in sexual risk behaviours in three Australian states: New South Wales, Victoria and Queensland, 1998-2006. Sex Health 2008; 5:125-30. [PMID: 18588777 DOI: 10.1071/sh07076] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In Australia, the HIV epidemic is concentrated among gay men. In recent years, the number of new diagnoses stabilised in New South Wales (NSW), but increased in other states. We reviewed the trends in sexual behaviours to explain this difference. METHODS We used the Gay Community Periodic Surveys in NSW, Victoria and Queensland during 1998-2006 and restricted analyses to the 30-49 year olds who contribute most of the HIV cases. We used the chi(2)-test for trends in unprotected anal intercourse with casual partners (UAIC) and regular partners, number of partners, type of relationships, knowledge of HIV serostatus and its disclosure. We compared behaviours of HIV-positive and -negative men and men across states using logistic regression adjusted for the year of report. RESULTS Trends in behaviours differed across the states: following a period of increase, UAIC prevalence declined in NSW since 2001, but continued to increase in Victoria and Queensland. There were other changes in NSW that were not observed in Victoria and Queensland: a decline in factors increasing HIV risk (the proportions of men with multiple sex partners and men engaging in UAIC and not knowing or not disclosing HIV serostatus) and an increase in behaviours reducing it (the proportions of men in monogamous relationships and men disclosing HIV serostatus while having UAIC). CONCLUSION There were patterns of declining HIV risk behaviours in NSW, and increasing risk behaviours elsewhere, that mirrored recent changes in HIV case notifications in Australia. These data suggest that behavioural surveillance can predict changes in HIV epidemiology.
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Affiliation(s)
- Iryna B Zablotska
- National Centre in HIV Social Research, University of New South Wales, Sydney, NSW 2052, Australia.
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Zablotska IB, Gray RH, Serwadda D, Nalugoda F, Kigozi G, Sewankambo N, Lutalo T, Mangen FW, Wawer M. Alcohol use before sex and HIV acquisition: a longitudinal study in Rakai, Uganda. AIDS 2006; 20:1191-6. [PMID: 16691071 DOI: 10.1097/01.aids.0000226960.25589.72] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association between alcohol use and HIV acquisition. DESIGN AND METHODS We examined alcohol use before sex and incident HIV in a population-based cohort in Rakai, Uganda, between 1994 and 2002. Adjusted incidence rate ratios (adjIRR) of HIV acquisition and 95% confidence intervals (CI) were estimated by Poisson multivariate regression. We also estimated adjusted prevalence rate ratios to assess the association between alcohol use and the number of sex partners and consistency of condom use. RESULTS In 6791 men and 8084 women HIV incidence was 1.4 per 100 person-years and 1.5 per 100 person-years, respectively. After adjustment for sociodemographic and behavioral factors, the risks of HIV when one partner consumed alcohol before sex were: adjIRR 1.67, 95% CI 1.17-2.40 among men, and adjIRR 1.40, 95% CI 1.02-1.92 among women, and when both partners consumed alcohol the risks were adjIRR 1.58, 95% CI 1.13-2.21 among men, and adjIRR 1.81, 95% CI 1.34-2.45 among women. Alcohol use was significantly associated with inconsistent condom use and multiple sexual partners in both sexes. CONCLUSION The use of alcohol before sex increases HIV acquisition. A reduction of alcohol use should be incorporated into HIV prevention programmes.
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Affiliation(s)
- Iryna B Zablotska
- Department of Population and Family Health Sciences, Bloomberg School of Public Health, The Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21218, USA.
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