ORCID Profile
0000-0001-5834-8278
Current Organisation
UNSW Sydney
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2020
Publisher: Springer Science and Business Media LLC
Date: 2022
DOI: 10.1007/S10508-021-02276-2
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.
Publisher: Springer Science and Business Media LLC
Date: 20-12-2020
DOI: 10.1007/S10508-019-01540-W
Abstract: Gay and bisexual men engage in a variety of sexual partnerships, but the most common distinction made in HIV research and behavioral surveillance is a binary between "regular" and "casual" partners. The "regular partner" category is often perceived as pertaining to ongoing coupled "boyfriend" relationships, with the literature to date rarely troubling what actually constitutes a "regular partner." Some emerging literature has identified "fuckbuddy" partnerships as a type of regular partnership requiring attention, but it is relatively new and not well understood. Currently, assumptions of the regular partner category do not capture how men perceive and conduct commitment in different sexual partnerships that could also be considered "regular," and the implications this has for HIV prevention. Drawing on in-depth interviews with a s le of 61 Australian gay-identified men, we explore a ersity of partnership types that represent unique ways of enacting commitment. We identify three sexual partnerships: "fuckbuddies," dating, and serial monogamy, each with specific issues for HIV risk and prevention. These partnerships suggest important differences in the way men conceive of and practice intimacy and sex.
Publisher: Wiley
Date: 07-08-2020
Publisher: Springer Science and Business Media LLC
Date: 27-07-2022
DOI: 10.1007/S10461-022-03788-1
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 s le, 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 s le 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.
Publisher: Springer Science and Business Media LLC
Date: 17-06-2022
DOI: 10.1007/S10461-021-03344-3
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.
Publisher: Springer Science and Business Media LLC
Date: 27-09-2023
Publisher: Springer Science and Business Media LLC
Date: 28-05-2023
DOI: 10.1007/S13178-022-00733-8
Abstract: 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. 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. 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. 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.
Publisher: Oxford University Press (OUP)
Date: 05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2022
Publisher: Springer Science and Business Media LLC
Date: 08-08-2020
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 04-09-2014
Publisher: UNSWorks, UNSW
Date: 2020
Publisher: BMJ Publishing Group Ltd
Date: 07-2019
Publisher: Informa UK Limited
Date: 07-11-2018
DOI: 10.1080/13691058.2017.1392614
Abstract: When viewed over time, many gay men's relationships are not static, or firmly fixed to monogamy or non-monogamy. This paper uses in-depth interviews with 61 Australian gay men to explore how monogamy and non-monogamy are experienced over time, expectations of what constitutes the norms regarding gay men's relationships and how couples experience and practices change. Although some gay men may idealise monogamy, particularly at the beginning of a relationship, it is often experienced as temporary. Non-monogamy is often seen as a likely prospect for gay relationships owing to the social and cultural norms that operate in gay communities. These expected trajectories are reflected in practice - many relationships begin monogamously and then become non-monogamous over time. While the application of 'rules', experimentation and flexibility can facilitate change, couples may struggle to navigate new territory as their relationship structures shift. This is particularly the case when partners value monogamy and non-monogamy differently, or when one partner's values change. These findings shed light on how gay men approach change to the status of 'fidelity' within their relationships, and the tensions and opportunities that change can produce for couples.
Publisher: MDPI AG
Date: 22-07-2021
DOI: 10.3390/TROPICALMED6030139
Abstract: In recent years, prevalence of Human Immunodeficiency Virus (HIV) has increased substantially in Bali, Indonesia, in men who have sex with men (MSM) and transgender women, known locally as ‘waria’. There are limited behavioural data in this population. We conducted a behavioural survey of MSM/waria in Bali in March–April 2018. Respondents were primarily recruited by HIV outreach workers. Respondents reported details about anal intercourse events with their last male/waria romantic partner and/or last male/waria casual partner (respondents could report on both if relevant). Statistical significance was tested with generalised estimating equations. Among 709 participants, median age was 27 (interquartile range = 24–31), and 92.1% were male and 7.9% were waria. One-third were born in Bali. Overall, 85.9% had ever had an HIV test 55.1% reported being HIV-negative, 15.0% HIV-positive, and 30.0% had unknown serostatus. Most (86.5%) reported sex with men, 9.5% with waria, and 20.0% with women in the previous 6 months. Respondents described 703 anal intercourse events (397/306 with romantic/casual partners, respectively 191 reported on both). Over half (56.5%) of the events were protected by condoms and 7.3% by biomedical prevention (2.6% by PrEP in either partner, 4.7% by HIV treatments in either partner). Thus, 36.3% of events involved unprotected condomless anal intercourse (40.8%/30.4% in romantic/casual partners, respectively). In multivariate analysis, unprotected condomless anal intercourse events were associated with romantic partners (p 0.001), being born in Bali (p = 0.002), lower education (p = 0.013), believing that withdrawal before ejaculation is effective (p 0.001), liking to use withdrawal (p = 0.021), and not liking condoms (p 0.001). One-quarter of events had potentially reduced HIV transmission risk through non-condom-based risk reduction strategies, while 11.1% had no potential risk reduction. Events presenting the highest potential risk of HIV transmission were more commonly reported by respondents born in Bali.
Publisher: American Medical Association (AMA)
Date: 23-12-2020
Publisher: Elsevier BV
Date: 08-2021
Publisher: BMJ Publishing Group Ltd
Date: 07-2021
Publisher: Springer Science and Business Media LLC
Date: 09-11-2021
DOI: 10.1186/S12889-021-12011-0
Abstract: HIV self-testing was proved as an effective tool for increasing testing frequency in gay and bisexual men at high risk of infection. Questions remain about understanding why HIVST encouraged testing and how such success can be translated to programmatic implementation. We conducted a qualitative investigation of how FORTH participants experienced and perceived HIVST. Stratified s ling was used to recruit gay and bisexual men participating in the FORTH HIVST intervention to take part in interviews, focusing on infrequent testers and those who had received inaccurate HIVST results. Our analysis identified several prominent themes organized into two overarching domains from the 15 interviews: (i) aspects of HIVST contributing to HIV testing frequency, and (ii) sustaining HIVST into the future. Participants also believed that their use of HIVST in the future would depend on the test kit’s reliability, particularly when compared with highly reliable clinic-based testing. HIVST increases the frequency of HIV testing among gay and bisexual men due, in part, to the practical, psychological, and social benefits it offers. To capitalize fully on these benefits, however, strategies to ensure the availability of highly reliable HIVST are required to sustain benefits beyond the confines of a structured research study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: Oxford University Press (OUP)
Date: 19-08-2023
DOI: 10.1093/CID/CIAC660
Abstract: Most human immunodeficiency virus (HIV) seroconversions in people who have initiated preexposure prophylaxis (PrEP) occur in the context of insufficient adherence. We describe participants who seroconverted after being dispensed PrEP in a large PrEP implementation study in Australia. Expanded PrEP Implementation in Communities in New South Wales was an implementation study of daily oral PrEP in in iduals aged ≥18 years at high risk for acquiring HIV. HIV seroconversions were defined as a positive HIV test by either antigen, antibody, or detectable HIV viral load after enrollment. Insufficient adherence, measured by dispensing logs or participant self-report, was defined as & PrEP doses per week. A total of 9596 participants were enrolled and dispensed PrEP between 1 March 2016 and 30 April 2018 30 were diagnosed with HIV by 31 March 2019. The median (interquartile range [IQR]) age was 31 (25–38) years, all identified as male, 29 (97%) identified as gay or homosexual, and 20 (69%) lived in a postcode with a low concentration of gay male residents. The median (IQR) days from first PrEP dispensing to diagnosis was 409 (347–656). There was no evidence that participants who seroconverted had been sufficiently adherent to PrEP. Nineteen (63%) participants who seroconverted were diagnosed with chlamydia, gonorrhoea, syphilis, or new hepatitis C infection. One participant had resistance to emtricitabine (M184V mutation) at diagnosis. Participants who seroconverted were insufficiently adherent to PrEP despite being at high risk for acquiring HIV. Understanding the reasons for poor PrEP adherence in in iduals who subsequently acquire HIV is critical to improving PrEP effectiveness.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Springer Science and Business Media LLC
Date: 08-02-2022
DOI: 10.1007/S10461-022-03611-X
Abstract: Successful use of biomedical forms of HIV risk-reduction may have predisposed many gay and bisexual men (GBM) to vaccination against COVID-19, which may, in turn, affect their sexual behavior. A total of 622 Australian GBM provided weekly data on COVID-19 vaccination history and sexual behaviour between 17 January 2021 and 22 June 2021. We identify factors associated with COVID-19 vaccination, and compare sexual behavior before and since vaccination. Mean age was 47.3 years (SD 14.0). At least one-dose vaccination coverage had reached 57.2%, and 61.3% reported that the majority of their friends intended to be vaccinated. Vaccinated men reported a mean of 1.11 (SD 2.10) weekly non-relationship sex partners before vaccination and 1.62 (SD 3.42) partners following vaccination. GBM demonstrated high confidence in COVID-19 vaccines. Their sexual activity increased following vaccination suggesting that greater sexual freedom may be a specific motivation for vaccine uptake among some men.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2022
DOI: 10.1007/S10508-021-02203-5
Abstract: Despite an increase in the range of effective HIV risk reduction strategies that are available, some gay and bisexual men (GBM) do not use any of them consistently. Understanding why GBM do not always use a protective strategy may help develop more effective responses. Semi-structured interviews with 24 sexually active GBM in Sydney, Australia were conducted and analyzed using thematic analysis. The main characteristics of encounters featuring little or no use of HIV risk reduction strategies were familiarity and trust with partners, pleasure and intoxication, expectations that partners were using HIV pre-exposure prophylaxis or treatment as prevention, and in some cases feelings of inevitability about acquiring HIV. An increase in pleasure and a reduction in anxiety about sex were noted by some GBM who had commenced PrEP. Encouraging GBM to adopt a strategy such as PrEP and to use it consistently may be easier by emphasizing benefits to mental health and the quality of sex and intimacy it can offer. However, even with the increased availability of effective biomedical HIV risk reduction strategies, not all GBM are able to consistently manage HIV risk and some continue to hold optimistic and potentially inaccurate beliefs about sexual partners that may increase HIV risk.
Publisher: Cold Spring Harbor Laboratory
Date: 05-12-2022
DOI: 10.1101/2022.12.01.22282999
Abstract: We assessed knowledge and concern about mpox, acceptability of behavioural changes to reduce transmission risk, and willingness to be vaccinated among gay, bisexual and queer-identifying men and non-binary people. We conducted a national, online cross-sectional survey with a convenience s le between August 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 16 years 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. Of 2287 participants, most participants were male (2189/2287 95.71%) and gay (1894/2287 82.82%). Nearly all had heard about mpox (2255/2287 98.60%), and the majority were concerned about acquiring it (1461/2287 64.42%). Most of the 2268 participants not previously diagnosed with mpox identified skin lesions (2087 92.02%), rash (1977 87.17%), and fever (1647 72.62%) as potential symptoms, and prolonged and brief skin-to-skin contact as potential ways to acquire mpox (2124, 93.65% and 1860, 82.01% respectively). The most acceptable behavioural changes were reducing or avoiding attendance at sex parties (1494 65.87%) and sex-on-premises venues (1503 66.40%), and having fewer sexual partners (1466 64.64%). Most unvaccinated and undiagnosed participants were willing to be vaccinated (1457/1733 84.07%). People at risk of mpox should be supported to adopt acceptable risk reduction strategies during outbreaks and seek vaccination.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2014
DOI: 10.1007/S10461-014-0755-6
Abstract: The prevalence and factors associated with being paid and paying for sex were explored in an online s le of Australian gay men. Sexual risk behavior among male sex workers and their clients was mainly related to being more sexually adventurous in general rather than male-to-male sex work specifically.
Publisher: UNSWorks, UNSW
Date: 2021
DOI: 10.26190/3GK3-2Z83
Publisher: Wiley
Date: 04-2019
DOI: 10.1002/JIA2.25277
Publisher: Springer Science and Business Media LLC
Date: 29-03-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-12-2021
Publisher: UNSWorks, UNSW
Date: 2020
Publisher: Elsevier BV
Date: 07-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/FTWC-SB56
Publisher: Springer Science and Business Media LLC
Date: 09-06-2021
Publisher: Springer Science and Business Media LLC
Date: 04-07-2021
DOI: 10.1186/S12889-021-11365-9
Abstract: 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. 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. 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. 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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2021
Publisher: BMJ
Date: 09-2015
Publisher: BMJ
Date: 09-2015
Publisher: Elsevier BV
Date: 08-2018
Publisher: SAGE Publications
Date: 25-08-2021
DOI: 10.1177/10497323211039204
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.
Publisher: Springer Science and Business Media LLC
Date: 17-06-2022
DOI: 10.1007/S13178-022-00736-5
Abstract: 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. We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBQM in Australia to understand PrEP dosing behaviors, knowledge, and preferences. 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. 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.
Publisher: Springer Science and Business Media LLC
Date: 19-11-2020
DOI: 10.1007/S10461-019-02737-9
Abstract: Using repeated, cross-sectional behavioural surveillance data from Australia, we assessed trends in relationship agreements and casual sex among HIV-negative and untested gay and bisexual men who had regular partners during 2013-2018. We conducted three analyses: (i) trends in relationship agreements and casual sex over time (ii) bivariate comparisons of PrEP users and non-PrEP-users to identify factors associated with PrEP use and (iii) multivariate logistic regression to identify factors independently associated with PrEP use. The analysis of trends over time included 21,593 men, from which a sub-s le (n = 3764) was used to compare PrEP users and non-PrEP-users. We found a large increase in agreements that allowed condomless sex with casual partners, particularly by PrEP users in relationships (nearly 40% of whom had such an agreement). A further 34% of PrEP users reported having casual condomless sex without an agreement that permitted that behaviour, while 13% of non-PrEP-users also reported condomless sex with casual partners without an agreement. PrEP use was independently associated with having agreements permitting condomless sex with casual partners, recent condomless sex with casual partners, having greater numbers of male partners, recent post-exposure prophylaxis use, having an HIV-positive regular male partner, and recent condomless sex with regular male partners. Our findings show a shift away from relationship agreements in which condomless sex was only sanctioned between regular partners.
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2018
Publisher: Wiley
Date: 19-04-2021
DOI: 10.1111/HIV.13102
Abstract: 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. We analysed HIV testing data from existing passive and sentinel surveillance systems between 2010 and 2018. 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. 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 .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 .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 .001 for all).
Publisher: SAGE Publications
Date: 18-12-2022
DOI: 10.1177/10497323211058162
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 in iduals and communities are already doing to enhance access to HIV services and the effective support strategies of some non-governmental organizations and healthcare workers.
Publisher: BMJ Publishing Group Ltd
Date: 07-2019
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/F57Q-0E06
Publisher: BMJ Publishing Group Ltd
Date: 07-2019
Publisher: BMJ Publishing Group Ltd
Date: 07-2019
Publisher: UNSWorks, UNSW
Date: 2020
Publisher: Public Library of Science (PLoS)
Date: 07-01-2016
Publisher: UNSWorks, UNSW
Date: 2020
Publisher: Wiley
Date: 2015
Publisher: Springer Science and Business Media LLC
Date: 22-02-2023
DOI: 10.1007/S10461-023-04013-3
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 ersity 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.
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3933637
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2020
Publisher: Springer Science and Business Media LLC
Date: 10-2021
Publisher: Elsevier BV
Date: 08-2013
Abstract: To use existing evaluation data of community-based HIV prevention peer education workshops (PEWs) for gay men to explore the challenges in evaluating such programs in community settings. Data came from 33 PEWs conducted with gay and bisexual men. A basic pre ost-test design was used to measure sexual health capacity. The Sexual Health Capacity Scale (SHCS) was anonymously completed before participation and twice afterward, with the men measuring perceptions of themselves before participation and perceptions of themselves after participation. The anonymous nature of the SHCS created problems for matching data so, for the most part, independent s les tests were used for analysis. Overall, 399 gay and bisexual men participated in PEWs. Participants perceived themselves as having more sexual health capacity after participation than before (p<0.001). Those who had previously been HIV tested before the PEW had higher perceived capacity (p<0.001). Participation in the PEWs appeared to increase the perceived sexual health capacity of gay and bisexual male participants. Several limitations in the data arose from issues in the original data collection. A mixture of anonymous and identifiable data-sources meant that data could not always be matched to in iduals. Stronger partnerships between HIV researchers and professionals within community organisations could significantly improve evaluation of the effectiveness of HIV peer education.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16054
Abstract: Background: How gay and bisexual men (GBM) establish partnership agreements may be affected by several factors, including age. The ability to communicate with a partner about sexual agreements has important sexual health implications for GBM. Objective: To assess differences in partnership agreements among GBM. Methods: We surveyed GBM about their partnerships using a national, anonymous online survey in 2013–14. We compared men who had monogamous partnerships with men who had non-monogamous partnerships, according to age and other factors. Results: Regarding the nature of their partnership with their primary regular partner (PRP), younger men were less likely to have an agreement of any sort and were less likely to have discussed it. Younger men were more likely to report having a monogamous partnership, but they were also less likely to report condomless anal intercourse with their PRP. In multivariate analysis of partnership arrangements, having a non-monogamous partnership with their PRP was associated with being older (adjusted odds ratio = 1.03 95% confidence interval = 1.02–1.04 P 0.001). Nearly two-thirds (62.9%) of men with monogamous partnerships had a clear spoken agreement with their PRP about whether they could have sex with other men, largely regardless of age. Although slightly fewer than half the men with self-described open partnerships (46.0%) actually described it as a ‘relationship’, younger men were particularly less likely to do so. Conclusions: Due to less communication with partners about sexual agreements, when young GBM engage in sexual risk behaviour they may be at an increased risk of HIV and other sexually transmissible infections.
Publisher: Elsevier BV
Date: 07-2021
Publisher: BMJ
Date: 06-01-2020
Publisher: Springer Science and Business Media LLC
Date: 12-03-2019
DOI: 10.1007/S10461-019-02435-6
Abstract: In Australia, HIV testing services have become increasingly available in non-traditional settings such as peer-led, community-based services to expand access and increase uptake of HIV testing among gay and bisexual men (GBM). This study aimed to compare the socio-demographic and behavioural characteristics of GBM whose last HIV test was conducted at a community-based service to GBM whose last test was at a traditional clinical setting. We analysed behavioural surveillance data collected from 5988 participants in seven states and territories in the period 2016-2017. We found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings, particularly in terms of sexual practice and risk of HIV. However, non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study points to the successful establishment of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2019
DOI: 10.1007/S10508-018-1308-2
Abstract: We investigated the racial or ethnic partner preferences among Australian gay and bisexual men (GBM) as part of a large study of sexual preferences among GBM, to identify whether racial bias was a factor in how GBM expressed their partner preferences. We surveyed 1853 Australian GBM about their partner preferences and preferred sex practices. We used logistic regression to identify whether factors such as age, gay social engagement, or men's own ethnicity or race were associated with ethnic and racial partner preferences. Mean age was 34.8 years. Ethnic or racial background included: white or "Caucasian" (86.6%), Australian Aboriginal (2.7%), and Asian (6.6%). Mean attraction scores were highest for "Caucasian" men, and lowest for Aboriginal and Asian men. Under half (41.6%) were attracted to all racial or ethnic types 7.7% were only attracted to "Caucasian" men. Being older and lower homonegativity scores were independently associated with finding all ethnic and racial types attractive. Being attracted only to "Caucasian" men was associated with younger age. Mental health was not associated with ethnic or racial partner preferences. Although men more commonly found most racial or ethnic types attractive, racial biases in partner selection were more evident among younger men, and among those who were less comfortable with their own sexuality. Addressing anti-gay stigma and broader exposure to gay community subcultures may be as important in countering racial bias.
Publisher: BMJ
Date: 09-2015
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/S8DV-S822
Publisher: CSIRO Publishing
Date: 21-08-2023
DOI: 10.1071/SH23050_CO
Abstract: b i Background /i : /b 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 s le of gay and bisexual men in Australia. b i Methods /i : /b We conducted a national, online cross-sectional survey in April& #x2013 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). b i Results /i : /b 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. b i Conclusions /i : /b 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.
Publisher: Springer Science and Business Media LLC
Date: 09-2022
DOI: 10.1007/S10461-022-03831-1
Abstract: Gay, bisexual, and other men who have sex with men (GBM) have developed community norms for regular HIV/STI testing. We investigated factors associated with self-reported COVID-19 testing in response to reported COVID-19 cases and public health restrictions. Participants responded to weekly cohort surveys between 10th May 2021 and 27th September 2021. We used the Andersen-Gill extensions to the Cox proportional hazards model for multivariable survival data to predict factors influencing COVID-19 testing. Mean age of the 942 study participants was 45.6 years (SD: 13.9). In multivariable analysis, GBM were more likely to report testing during periods of high COVID-19 caseload in their state of residence if they were younger university educated close contact of someone with COVID-19 or reported coping with COVID-19 poorly. COVID-19 testing was higher among men who: were more socially engaged with other GBM had a higher proportion of friends willing to vaccinate against COVID-19 and were willing to contact sexual partners for contact tracing. Social connection with other gay men was associated with COVID-19 testing, similar to what has been observed throughout the HIV epidemic, making community networks a potential focus for the promotion of COVID-19 safe practices.
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/5PM2-RG76
Publisher: MDPI AG
Date: 10-12-2018
Abstract: This study examined the prevalence and factors associated with inconsistent condom use among men who have sex with men (MSM) who use gay mobile geo-social networking applications (gay mobile apps) in Greater Tokyo. Among a s le of 1657 MSM recruited through advertisements on gay mobile apps, inconsistent condom use was reported by over one-third (37%) of participants with regular male partners, 18% with casual male partners, and 20% with female partners. In multiple regression analysis, inconsistent condom use with both regular and casual male partners was more commonly reported among participants without a university education, and among participants reporting lower self-efficacy for safer sex. Inconsistent condom use with casual male partners was more commonly reported among participants living in the central 23 wards of Tokyo. Inconsistent condom use with regular male partners was more commonly reported among participants who identified as a member of the gay community, and who only had male partners. These results indicate that a substantial proportion of Greater Tokyo gay mobile app users use condoms inconsistently, particularly with regular partners, and may be at risk for HIV. This paper provides useful information to help design tailored strategies to reduce inconsistent condom use.
Publisher: CSIRO Publishing
Date: 2023
DOI: 10.1071/SH23036
Publisher: CSIRO Publishing
Date: 03-08-2022
DOI: 10.1071/SH22101
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 c aigns 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 c aigns. 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.
Publisher: CSIRO Publishing
Date: 13-12-2021
DOI: 10.1071/SH21096
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 ided 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 29 years (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 %. 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 6 months 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.
Publisher: Elsevier BV
Date: 09-2021
Publisher: CSIRO Publishing
Date: 30-08-2022
DOI: 10.1071/SH22109
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 erse 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.
Publisher: Springer Science and Business Media LLC
Date: 16-09-2013
DOI: 10.1007/S10461-012-0309-8
Abstract: Since there is little evidence about gay community norms across the world, we reviewed published literature in this area and discuss implications for prevention and research. Eight databases were searched for articles and 16 were considered suitable for analysis. All used quantitative methodology and seven were based on a published theoretical framework. The most common theory employed by four out of the seven papers was the Theory of Reasoned Action. All papers reviewed examined norms on condom use but norms on other risk reduction practices were not explored in these papers. Seven (44 %) studies found those men who perceived strong social support from their peers, were less likely to engage in unprotected anal intercourse. This finding suggests that social support from partners and community members plays a role in shaping safe sex norms. Better understanding of norms may help to redress HIV behaviour change programmes, particularly at the time when HIV diagnoses rates are increasing in most gay communities across the world.
Publisher: Public Library of Science (PLoS)
Date: 23-01-2019
Publisher: Public Library of Science (PLoS)
Date: 10-11-2022
DOI: 10.1371/JOURNAL.PONE.0277226
Abstract: Female sex workers (FSWs) in Uganda are at high risk of HIV infection. Scaling up oral pre-exposure prophylaxis (PrEP) will reduce HIV incidence if high levels of adherence are maintained. This study evaluates PrEP adherence using clinic-based pill counts and self-reported measures, and factors associated with protective levels of adherence. Participants were sex workers who had been taking PrEP for at least 5 months and were attending routine follow-up visits for PrEP care in fishing communities and along the Trans-African Highway. Participants who had a pill count showing at least 85% use since their last clinic visit and those who reported taking their PrEP every day in the last 5 months were categorised as having ‘protective adherence’. Spearman’s correlation and weighted kappa assessed the relationship between pill count and self-reported measures. Bivariate and multivariate logistic regression was used to determine factors associated with protective adherence as measured by pill count. We recruited 524 FSWs, with a median age of 29 years (IQR 23–35). Participants were recruited from fishing communities and Trans-African Highway towns (n = 297, 56.7%, and n = 227, 43.0%). Nearly three quarters (n = 372, 71.0%) of women were estimated to have protective adherence based on pill count (i.e., a pill count of %) and 50.4% by self-report in last 3 months. There was a strong positive association between self-reported measures and pill count measures ( r est = 0.6453, 95% CI = 0.5924–0.6927) and a moderate agreement between self-reported measures and pill count measures, κ = 0.544 (95%CI = 0.4869–0.6011, p 0.001). Factors associated with protective adherence included being aged 35 years or older (aOR = 2.40, 95% CI = 1.17–4.86), living in a fishing community (aOR = 1.45, 95% CI = 0.62–3.38), and having an STI in last 3 months (aOR = 1.64, 95% CI = 1.07–2.49). Our findings indicate that PrEP-experienced FSWs attending clinical follow-up visits reported high protective levels of oral pre-exposure prophylaxis, as measured by both pill count and self-reported measures, and a moderate agreement between pill count and self-reported measures.
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/TBQA-M183
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH15099
Abstract: Background The awareness and previous and intended use of HIV self-testing (HST), and the associated factors, among Australian gay and bisexual men (GBM) was investigated. Methods: An online cross-sectional survey was conducted in Australia during 2012. Of 1410 respondents, 559 non-HIV-positive men answered questions about HST. Results: Men reported reasons for having avoided or delayed HIV testing, most of which could be broadly categorised as: the inconvenience of current testing procedures concerns about privacy and a belief that they had not done anything risky. Over one-third of men (39.7%) were aware that HST was available internationally, with 1.6% having accessed HST through online purchase. The majority of men in the study indicated that they would be ‘likely’ (36.5%) or ‘very likely’ (34.3%) to use HST if it was available in Australia. Also, 36.7% indicated they would test partners they met at sex-on-site venues, and 73.2% would test partners with whom they were already acquainted. Nearly half (47.6%) indicated that having the capacity to test themselves at home would likely increase their testing frequency. Men who had engaged in unprotected anal intercourse, who were not gay-identified, and who indicated inconvenience issues with using clinic-based HIV testing were more likely to indicate a willingness to use HST. Many men indicated they would be likely to offer HST to at least some of their sex partners. Conclusion: Many GBM who engage in HIV risk behaviours would appreciate HST, and may be encouraged to test more often, as it may alleviate their concerns about testing.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16100
Abstract: Background Regular testing of in iduals at higher-risk of HIV is central to current prevention strategies. The aim of the present study was to examine the extent to which confidence in one’s perceived ability to undertake various aspects of HIV testing and self-testing (self-efficacy) affected HIV testing outcomes. We assessed factors, including self-efficacy, associated with HIV testing frequency and the likelihood to self-test among gay and bisexual men (GBM). Methods: Participants were HIV-negative GBM at an increased risk of HIV (more than five partners or condomless anal intercourse in the previous 3 months) enrolled in a randomised controlled trial of HIV self-testing. The baseline questionnaire captured data regarding sociodemographic characteristics, HIV and/or sexually transmissible infection testing history, sexual behaviour, beliefs and attitudes towards HIV and eight items capturing confidence in HIV testing ability that were combined as a single broad measure of HIV testing self-efficacy (α = 0.81). Factors associated with three or more HIV tests in the past year and the likelihood of self-testing in the future were determined using logistic regression. Results: Of 354 GBM, 34% reported three or more HIV tests in the past year, and 64% reported being ‘very likely’ to self-test. Factors independently associated with three or more HIV tests in the past year were: higher self-efficacy (adjusted odds ratio (aOR) 1.08 per unit increase 95% confidence interval (CI) 1.02–1.14 P = 0.004) male partners in the past 6 months (aOR 1.79 95% CI 1.05–3.04 P = 0.031) and higher optimism regarding the effects of HIV treatments on HIV transmission (aOR 1.14 95% CI 1.00–1.29 P = 0.044). Only higher self-efficacy was independently associated with reporting a greater likelihood to self-test in the future (aOR 1.10 95% CI 1.05–1.15 P 0.001). Conclusions: Improving self-efficacy by enhancing GBM’s knowledge and experience may lead to higher testing frequency. The self-efficacy measure used in the present study could be useful in identifying GBM likely to face difficulties with HIV testing and self-testing.
Publisher: Public Library of Science (PLoS)
Date: 14-02-2019
Publisher: Informa UK Limited
Date: 31-05-2016
DOI: 10.1080/13691058.2016.1184314
Abstract: Same-sex marriage is a widely debated issue, including in Australia. This study used an online anonymous survey, with free-text responses, to investigate romantic and sexual relationships among Australian gay and bisexual men. We sought to identify what proportion of such men intended to marry their primary regular partner if marriage was made legally available to same-sex couples in Australia, as well as factors associated with intention or non-intention to marry. Most men in the s le did not intend to marry their primary regular partner. Even among men who considered themselves to be in a 'relationship' with their primary regular partner, less than half intended to marry him. However, many men who would not marry their current primary regular partner agreed that same-sex marriage should be available for gay and bisexual men in Australia. Reasons for intention to marry included a desire for social and legal equality, and ideas about marriage as a rite of passage, an expression of love and the most valued form of relationship in Australia. Those who did not intend to marry their primary regular partner offered a number of reasons, including that the nature of their relationship was incompatible with marriage, and reported a critical position towards marriage as a heteronormative institution.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16191
Abstract: Background Among gay and bisexual men (GBM), ‘serosorting’ is common and involves restricting sex, or at least condomless sex, to partners of the same HIV status. The prevalence of men conveying their serosorting preferences regarding partners they meet online remains unclear. Methods: This study reviewed 57 178 Australian online profiles obtained directly from a popular gay website. Logistic regression was used to identify factors associated with preferences for meeting HIV-positive partners. Results: Men could indicate their preferences from a list of 22 types of partners 4358 profiles (7.6%) indicated an interest in meeting HIV-positive men. There were 1959 profiles (3.4%) listing a preference for 21 of the 22 types of men, including 1498 men (2.6%) that specifically excluded HIV-positive men. Men who specifically excluded HIV-positive men on their profiles were younger (mean age 34.7 years), less likely to identify as gay (25.6%) and more likely to always prefer ‘safer sex’ (55.3%) than those who specifically included them (mean age 39.6 years 62.8% gay-identified 30.9% preferred safer sex P 0.001). Men who specifically excluded HIV-positive partners on their profiles were also more likely to live outside major capital cities (P 0.001). Conclusions: Being younger, living outside major cities, not identifying as gay, always preferring safer sex and either Caucasian or Asian background were associated with excluding HIV-positive men as potential sex partners. These factors may reflect lower social and community engagement with the gay community. The disinclination to include HIV-positive men as potential sex partners may be due to fear of infection, stigma or poor information about HIV.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16198
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.
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/DTWE-JH83
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 07-06-2022
DOI: 10.1007/S10508-022-02310-X
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.
Publisher: Springer Science and Business Media LLC
Date: 08-08-2023
DOI: 10.1007/S10508-022-02382-9
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.
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-11-2023
DOI: 10.1097/OLQ.0000000000001731
Abstract: Gay and bisexual men (GBM) who use HIV preexposure prophylaxis (HIV-PrEP) have high rates of bacterial sexually transmitted infections (STIs). The use of daily antibiotics as STI preexposure prophylaxis (STI-PrEP) may be appealing to GBM who are using or have previously used HIV-PrEP (HIV-PrEP–experienced) for the prevention of bacterial STIs. We examined willingness to use daily STI-PrEP among a cross-sectional s le of HIV-PrEP–experienced GBM in Australia who participated in an observational online cohort study from August 2018 to March 2020. Factors associated with willingness to use daily STI-PrEP were determined using bivariate and multivariate logistic regression. Of the 1347 participants, half (54.3%) were willing to use daily STI-PrEP. Factors independently associated with greater willingness to use daily STI-PrEP included having sexual partners in the last 6 months, using meth hetamine in the last 6 months, being more conscious about avoiding STIs, having a greater number of STIs since commencing HIV-PrEP, being willing to take HIV-PrEP for as long as they were at risk of acquiring HIV, and only using condoms when a sexual partner requested them. Conversely, factors associated with less willingness to use daily STI-PrEP included being university educated, using nondaily dosing regimens of HIV-PrEP, preferring event-driven HIV-PrEP, and being concerned about long-term HIV-PrEP adverse effects. Sexually transmitted infection PrEP is likely to be appealing to many HIV-PrEP–experienced GBM, especially those who engage in activities associated with a higher risk of STI transmission. However, they are less likely to be willing to use STI-PrEP unless it aligns with their HIV-PrEP dosing regimen, suggesting that research into the safety and efficacy of alternative STI prophylaxis dosing options should be prioritized.
Publisher: Springer Science and Business Media LLC
Date: 23-12-2020
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: Oxford University Press (OUP)
Date: 03-2014
DOI: 10.1111/JSM.12407
Publisher: Springer Science and Business Media LLC
Date: 13-08-2018
DOI: 10.1007/S10461-018-2247-6
Abstract: Many gay Australian serodiscordant couples are currently relying on an HIV-positive partner's undetectable viral load (UVL) to practice condomless sex. For these couples, preventing HIV is often considered a mutual responsibility, yet they lack a formally endorsed strategy that helps them navigate 'UVL for prevention' (UfP) as a couple. Drawing on interviews with 21 Australian gay men representing 15 serodiscordant couples, we explored 'the couple' within serodiscordant HIV prevention. In learning to rely on UfP, couples were initially apprehensive as they navigated unfamiliar territory, but their concerns faded over time. Confidence in UfP was facilitated by repeated condomless sex without transmission, consistent test results, and being in a couple framed by trust, commitment, and familiarity. Gay male serodiscordant couples should be encouraged to negotiate clear, spoken 'viral load agreements' (VLAs) if they choose to rely on UfP.
Publisher: Oxford University Press (OUP)
Date: 05-2017
Publisher: Frontiers Media SA
Date: 12-01-2023
DOI: 10.3389/FPUBH.2022.1064408
Abstract: Gay, bisexual and other men who have sex with men (GBMSM) and trans and gender erse (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). We distributed an anonymous online survey from April to August 2021among the lesbian, gay, bisexual, transgender, intersex, queer and other people of erse 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. 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%). 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.
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/P2GH-N362
Publisher: Centre for Social Research in Health, UNSW, Sydney: UNSW Centre for Social Research in Health
Date: 2022
DOI: 10.26190/Y2R6-2P17
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-06-2021
Publisher: Wiley
Date: 2023
DOI: 10.1002/JIA2.26056
Abstract: 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. 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. 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 ( patients) prescribers (31.1%, p .001), and by prescribers practising in areas with low estimated prevalence ( .0%) of gay men (64.1%) than high ( %) prevalence (36.7%, p .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 .001), low estimated gay prevalence of prescriber location (aHR 1.98, p .001) and low prescriber PrEP caseload (aHR 1.79, p .001). 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.
Publisher: BMJ Publishing Group Ltd
Date: 07-2021
Publisher: UNSWorks, UNSW
Date: 2020
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/DY2G-Q958
Publisher: Springer Science and Business Media LLC
Date: 23-01-2020
DOI: 10.1007/S10461-020-02797-2
Abstract: Data from repeated, national behavioural HIV surveillance was used to identify similarities and differences between young gay and bisexual men (YGBM) aged 16-24 (n = 1608) and older GBM aged 25-49 (n = 6266), in order to quantify risks and identify gaps in HIV prevention. Trend analyses from 2014 to 2018 are also reported. While there were similar rates of condomless anal intercourse with casual partners in both age groups, YGBM had lower rates of HIV testing and PrEP use but also fewer male partners. Our results suggest most YGBM have lower HIV risk than older GBM but a minority merit enhanced testing and prevention efforts.
Publisher: Springer Science and Business Media LLC
Date: 06-03-2023
DOI: 10.1007/S10461-023-04019-X
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 s le 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.
Publisher: Wiley
Date: 12-07-2022
DOI: 10.5694/MJA2.51641
Abstract: To compare the usability and acceptability of oral fluid- and blood-based HIV self-test kits among men who have sex with men in Australia. Randomised crossover trial. Gay, bisexual, and other men aged 18 years or older who have sex with men, who attended two metropolitan sexual health clinics in Sydney and Melbourne, 7 January - 10 December 2019. Ease of use of HIV self-test kits preferred HIV self-test type difficulties encountered during HIV self-testing. 170 men were recruited (median age, 34 years interquartile range, 29-43 years) 144 identified as gay (85%), 96 were born outside Australia (57%). Participants were more likely to report the oral fluid HIV self-test was easy to use than the blood-based self-test (oral fluid, 99% blood, 86% odds ratio [OR], 3.0 95% confidence interval [CI], 1.4-6.6). The oral fluid test was preferred by 98 participants (58% 95% CI, 50-65%), the blood-based test by 69 (41% 95% CI, 33-48%). Difficulties with the oral fluid test kit identified by observing nurses included problems placing the buffer solution into the stand (40 of 170 participants, 24%) and not swabbing both gums (23 of 169, 14%) difficulties with the blood-based test kit included problems filling the device test channel (69 of 170, 41%) and squeezing the finger firmly enough to generate a blood drop (42 of 170, 25%). No participant received an invalid result with the oral fluid self-test two of 162 participants (1%) received invalid results with the blood self-test. After adjusting for age, education level, and ethnic background, characteristics associated with higher odds of using HIV self-testing in the future were overseas birth (adjusted OR, 3.07 95% CI, 1.42-6.64), and self-evaluated ease of use and confidence in using the kits. It is important to provide options for obtaining both oral fluid- and blood-based HIV self-tests. The usability and acceptability of both kits were high, but the ease of use and perceived accuracy influenced test kit preference.
Publisher: Springer Science and Business Media LLC
Date: 28-10-2023
DOI: 10.1007/S13178-022-00769-W
Abstract: Stigma is a significant contributor to the HIV diagnosis disparities experienced among migrants who are gay and bisexual men (GBM) living in high-income countries. We conducted interviews with 24 migrant GBM in Australia diagnosed with HIV from 2017 onwards, who since their diagnosis had become well-connected to sexual health services and participation in research. Interviews were conducted between October 2018 and December 2019. We aimed to identify how HIV and sexual identity stigmas were barriers to accessing HIV testing and prevention. These stigmas were deeply embedded into social, cultural, and institutional settings in participants’ countries of origin, resulting in poor HIV literacy, reluctance to access HIV-related services, including HIV testing, and fears of being identified as gay/bisexual publicly. Underpinned by internalised stigma, these fears and poor outcomes often persisted after moving to Australia. Other barriers to accessing HIV-related services in Australia included apprehension about a potential HIV-positive result and the possibility of visa cancellation, concerns about confidentiality, and a lack of confidence and support in navigating the healthcare system, including how to access pre-exposure prophylaxis. Addressing these multifaceted HIV testing and prevention barriers requires policies, systems, and interventions that increase health literacy about HIV testing, prevention, and treatment build trust and confidence when navigating Australian health services and reduce the impacts of HIV and sexual identity stigmas in migrants’ countries of origin on their experiences in Australia.
Publisher: MDPI AG
Date: 06-12-2020
DOI: 10.3390/V12121402
Abstract: Changes over time in HIV-1 subtype ersity within a population reflect changes in factors influencing the development of local epidemics. Here we report on the genetic ersity of 2364 reverse transcriptase sequences from people living with HIV-1 in New South Wales (NSW) notified between 2004 and 2018. These data represent % 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, in iduals 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.
Publisher: Guilford Publications
Date: 12-2022
DOI: 10.1521/AEAP.2022.34.6.453
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.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2022
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: CSIRO Publishing
Date: 29-06-2023
DOI: 10.1071/SH23050
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 s le 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.
Publisher: Elsevier BV
Date: 08-2021
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 22-05-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-07-2021
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/JVDK-BG23
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2021
Publisher: CSIRO Publishing
Date: 13-12-2022
DOI: 10.1071/SH22095
Abstract: Background The disclosure of HIV status and pre-exposure prophylaxis (PrEP) use can be important in the negotiation of safe sex. With the rapid uptake of PrEP in Australia, norms and expectations about discussion and disclosure may have changed. Methods We explored the disclosure of PrEP use, HIV status and communication with sex partners by HIV-negative gay men in Sydney, Australia. We conducted semi-structured interviews from October 2017 to May 2018 and analysed data using a codebook thematic analysis approach. Results Participants had a variety of expectations of what they should tell their partners and what they expected in return. For some participants, PrEP had negated the need for any discussion about HIV. Many participants assumed their partners would find information about their HIV status or PrEP use on their online profiles or that partners would ask, if necessary. Conclusions Building a stronger, shared understanding among gay men that disclosure and discussion no longer automatically occur before sexual encounters may be useful.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2019
Publisher: CSIRO Publishing
Date: 26-04-2022
DOI: 10.1071/SH21207
Abstract: Background Pre-exposure prophylaxis (PrEP) became available through the Australian Pharmaceutical Benefits Scheme (PBS) on 1 April 2018 for HIV infection prevention in patients ≥18 years at medium-to-high HIV risk. The aims were to investigate PrEP utilisation in general practice since PBS listing, and factors associated with discontinuation. Methods This longitudinal study included patients aged 18–74 years attending general practices participating in MedicineInsight, a large-scale national primary care database of deidentified electronic health records, between October 2017 and September 2019. Results PrEP utilisation increased 10-fold following PBS listing. On average, patients had 9.7 PrEP prescriptions per year a medication possession ratio of 80.8%. Of 1552 patients prescribed PrEP from April 2018, most were male (98.3%), aged 18–39 years (59.3%), resided in major cities (86.7%) and in the two most socioeconomically advantaged quintiles (70.0%). Almost half (49.1%) of the patients were identified as new to PrEP. At study end, 65.1% were on active PrEP (16.5%, of whom had non-continuous use), 19.2% had discontinued PrEP and 15.7% were lost to follow up. Patients who discontinued were more likely to attend low rather than high PrEP caseload practices (adjusted odds ratio [aOR] 1.7 95% CI: 1.0–2.8 P = 0.047). The odds of non-continuous therapy was 2.9-fold higher in patients with bipolar disorder (aOR 2.89 95% CI: 1.10–7.6 P = 0.045). Conclusions Following PBS listing, PrEP utilisation increased and stopping therapy was associated with attending low caseload practices. General practice education, particularly among low caseload practices, could help address these disparities.
Publisher: Wiley
Date: 13-11-2019
Abstract: Semen from HIV-1-infected men contains anti-HIV-1 antibodies and immunosuppressive factor(s). We assessed if suppression of viremia with antiretroviral therapy impacted seminal plasma immunosuppressive capacity or the Fc-dependent functions of seminal anti-HIV-1 antibodies. We also tested if active bacterial sexually transmitted infections altered the immunosuppressive capacity of seminal plasma.
Publisher: Informa UK Limited
Date: 03-01-2020
Publisher: BMJ
Date: 10-07-2013
DOI: 10.1136/SEXTRANS-2012-050947
Abstract: To describe the relationships between HIV-negative Australian gay men's sexual behaviour and differences in age between them and their sex partners. Anonymous computer-assisted internet survey was administered. We used multinomial logistic regression to examine factors associated with reported differences in partners' age (10 years older, within 10 years and 10 years younger) among 1476 men. Two-thirds of the men reported their most recent casual sex partners were within 10 years of age to themselves, as were 79.3% of their regular partners. Neither men's own age nor relative differences in age with their partners was associated with the likelihood to engage in unprotected anal intercourse. Among men who reported sex with a regular partner, those with older partners tended to restrict themselves to the receptive position (adjusted ORs (AOR)=2.00 95% CI 1.02 to 3.92 p=0.044). Among men who reported sex with a casual partner, those with younger partners tended to take the insertive position, both on occasions when a condom was used (AOR=2.42 95% CI 1.39 to 4.20 p=0.002) and on occasions when a condom was not used (AOR=2.54 95% CI 1.04 to 6.20 p=0.041). Age differences between gay men and their sex partners make little difference to the likelihood of engaging in sexual risk behaviour overall with either regular or casual partners. Those whose partners are substantially older than themselves are more likely, however, to take the receptive position during anal intercourse. Where risk of HIV infection among younger men is elevated this could be due to differences in sexual position, rather than differences in unprotected anal intercourse per se, during sex with men who are substantially older than themselves.
Publisher: Springer Science and Business Media LLC
Date: 11-03-2020
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/NR8P-AT84
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2022
Publisher: Frontiers Media SA
Date: 19-04-2022
Abstract: 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. 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. 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. 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.
Publisher: Hindawi Limited
Date: 15-09-2022
DOI: 10.1111/HSC.14011
Publisher: MDPI AG
Date: 10-10-2020
DOI: 10.3390/TROPICALMED5040158
Abstract: Indonesia has not implemented HIV pre-exposure prophylaxis (PrEP) despite global calls for its scale-up, and there is limited information about attitudes towards PrEP among its potential users. We aim to present a PrEP cascade among men who have sex with men (MSM) and transgender women (known locally as “waria”) in Denpasar, Bali, from a cross-sectional survey with 220 HIV-negative MSM/waria recruited from one clinic in Denpasar. Only 16.4% of participants had heard of PrEP before. From first-to-last steps included in the cascade, we found 77.3% (170/220) of participants were classified with HIV high risk, 75.9% (129/170) perceived themselves as being at high risk, 81.4% (105/129) expressed interest in using PrEP, 78.1% (82/105) were willing to do PrEP procedures, 48.8% (40/82) were willing to pay 500,000–600,000 IDR, and only two participants had ever been on PrEP before (5.0% of those willing to pay and 0.9% of the total s le). Multivariate logistic regression analysis showed that self-perception of high HIV risk was lower among older age groups (p 0.001 among 30–39 p = 0.002 among 40) and higher among participants with multiple sex partners (p = 0.016). Interest in using PrEP was lower among participants with high social engagement as MSM/waria (p = 0.002) and was higher among participants with multiple sex partners (p = 0.020) and inconsistent condom use (p = 0.011). This study has shown a significantly low level of PrEP awareness among its participants and decreases in interest in PrEP use due to procedure and cost. It suggested that an appropriate PrEP c aign is needed if PrEP is going to be introduced in Indonesia.
Publisher: BMJ Publishing Group Ltd
Date: 07-2019
Publisher: Wiley
Date: 2021
DOI: 10.1002/JIA2.25655
Abstract: 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. 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 s led 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. 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 in iduals 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 in iduals diagnosed during the early stage of infection ( p 0.05) and CRF01_AE singletons were more likely to be from infections among in iduals reporting heterosexual transmission ( p 0.05). We found six subtype B clusters with an above‐average growth rate ( .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 ( year) between infections and may be indicative of intermediate transmissions via undiagnosed in iduals. 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.
No related grants have been discovered for Benjamin Robert Bavinton.