Dean Murphy

Pre-exposure prophylaxis (PrEP) is the use of HIV anti-retroviral therapy to prevent HIV transmission in people at high risk of HIV acquisition. PrEP is highly efficacious when taken either daily, or in an on-demand schedule. In Australia co-formulated tenofovir-emtricitabine is registered for daily use for PrEP, however, this co-formulation is not listed yet on the national subsidized medicines list. We describe a study protocol that aims to demonstrate if the provision of PrEP to up to 3800 individuals at risk of HIV in Victoria, Australia reduces HIV incidence locally by 25% generally and 30% among GBM. PrEPX is a population level intervention study in Victoria, Australia in which generic PrEP will be delivered to 3800 individuals for up to 36 months. Study eligibility is consistent with the recently updated 2017 Australian PrEP guidelines. Participants will attend study clinics, shared care clinics, or outreach clinics for quarterly HIV/STI screening, biannual renal function tes...

It is well-established that a high prevalence of substance use is found in lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) populations; a finding that researchers attribute to the stigmatised status of non-normative sexual and gender expression, and the role of illicit drug use in the collective production of socio-sexual pleasures, expressivity and disclosure in LGBTIQ communities. Despite the connections between sexual experimentation and substance use, LGBTIQ consumption practices have rarely received the attention they deserve within the alcohol and other drug (AOD) field. In this paper, we draw on concepts from post-structuralist policy analysis to analyse how AOD consumption among sexual and gender minorities is constituted in the policies of three Australian LGBTIQ health organisations. Following Carol Bacchi's (2009, p. xi) observation that we are "governed through problematisations rather than policies", we consider how substance use in LGBTIQ...

We analyzed the concept of risk compensation and how it has been applied in HIV prevention, paying particular attention to the strategy of HIV preexposure prophylaxis (PrEP). In risk compensation, reduced perceptions of risk after the introduction of a preventative intervention lead to more frequent risk-taking behavior. Such a change may undermine the intervention's protective benefits. We found that many studies purporting to investigate risk compensation do not assess or report changes in perceptions of risk, instead relying on behavioral measures. Our analysis suggests a complex and sometimes counterintuitive relationship between the introduction of a new prevention intervention, perceptions of HIV risk, and subsequent changes in behavior. As PrEP is introduced, we believe comprehensive assessment of community-level risk compensation-that is, changes in risk perceptions and behavior as a result of increased optimism about avoiding HIV among people not directly protected by PrEP-should not be omitted. We therefore suggest ways to assess prevention optimism and community-level risk compensation.

Assess willingness to use HIV pre-exposure prophylaxis (PrEP), support for others using it and willingness to have sex with partners using PrEP among Australian gay and bisexual men (GBM). National, online cross-sectional surveys of Australian GBM were conducted in 2011, 2013 and 2015. Scales measuring support for and willingness to have sex with men using PrEP were developed in 2015 using factor analysis. Trends and associations with key measures were analysed using multivariate logistic regression. During 2011-2015, 3850 surveys were completed by GBM. Willingness to use PrEP among HIV-negative and untested men did not change between 2011 (28.2%) and 2015 (31.7%, p=0.13). In 2015, willingness to use PrEP was independently associated with younger age, having an HIV-positive regular partner, recent condomless anal intercourse with casual male partners (CAIC), more than 10 male sex partners in the previous 6 months, ever having taken postexposure prophylaxis and having fewer concerns ...

HIV Pre-exposure prophylaxis (PrEP) decreases risk of HIV acquisition however its efficacy is closely dependent on adherence. There is also concern that the preventive effect of PrEP may be offset by risk compensation, notably an increase in condomless anal sex. Multi-site, open-label demonstration study that recruited people at current or recent risk of HIV infection in Melbourne, Australia. Participants were recruited from three general practice clinics and one sexual health clinic in Melbourne and consented to take daily tenofovir/emtricitabine for 30 months. Sexual practice data, HIV and sexually transmitted infection (STI) test results were collected at baseline and 3-monthly during follow up. PrEP adherence was evaluated by self-report at clinical visits, online surveys, refill-based assessments and dried blood spot (DBS) testing. We present a 12-month interim analysis. 114 people were recruited. We observed a significant decline in condom use which occurred concomitantly with...

There are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. For gay men, drug and alcohol use can be a creative or experimental response to social marginalisation – and not necessarily a problematic one in every instance. Numerous studies have found that infection with HIV and other sexually transmissible infections (STIs) is more likely among gay and men who have sex with men (MSM) who use recreational drugs than those who do not, but the causal nature of these relations is uncertain. Sexualised drug use is associated with a range of other problems, including dependence, mental health issues, accident and overdose. A growing body of work in the Alcohol and Other Drugs (AOD) field demonstrates the action of drugs and their purported effects to be a product of their relations with various other actors, contexts and practices. Given these contingencies, it is impossible to predict the future of drugs or their effect on the ...

Australian health promotion campaigns encourage people to manage their alcohol consumption by avoiding involvement in a form of round drinking known as 'shouting'. We consider this individualist advice in light of our analysis of the social relations established by young people through collective drinking, in which we conceptualise friends, family and work colleagues as participants in complex networks of exchange. Data were gathered during in-depth, semistructured interviews and ethnographic fieldwork conducted in a socioeconomically disadvantaged outer suburb of Melbourne, Australia. The interview sample comprised nine men and seven women of diverse ethnic backgrounds, with a median age of 21 years. We identified two types of exchange-'shouting' and 'providing'-enacted by round drinking and other collective drinking practices. 'Shouting' is a form of balanced reciprocity in which participants take turns buying drinks for all others in the group. It ...

Introduction The term serodiscordant is generally used to describe people of different HIV antibody status. In this paper we focus solely on serodiscordant regular relationships. By this we mean intimate relationships in which one partner is known to be HIV-positive and the other HIV-...

We surveyed Australian gay and bisexual men, assessing belief in HIV treatment as prevention (TasP) and support for early treatment. We identified the characteristics of participants who believed in TasP and supported early treatment using multivariate logistic regression. In 2013, 1316 men participated; 1251 participated in 2015. Belief in TasP increased from 2.6 % in 2013 to 13.1 % in 2015 (p < 0.001). The increase was most noticeable among HIV-positive men (from 9.7 % to 46.2 %). Support for early treatment increased from 71.8 % to 75.3 % (p = 0.02). Belief in TasP was associated with being HIV-positive, having a tertiary education, having recent condomless anal intercourse with casual male partners, and ever having taken post-exposure prophylaxis. Support for early HIV treatment was associated with being younger, living in New South Wales and being in paid employment. We recommend continued monitoring of the growing gap in belief about TasP between HIV-positive men and HIV-negative/untested men.

Background: There are increasing reports of sexual transmission of hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM). Still unclear is the level of HCV knowledge and the risk factors specific to HCV transmission among this population. This study compared HCV knowledge and risk practices among HIV-positive, HIV-negative and HIV-untested gay and bisexual men in Australia. Methods: Participants (n = 534) completed an online survey assessing sexual risk practices, HCV knowledge, perceived risk of acquiring HCV and perceptions of people with HCV and who inject drugs. Results: HIV-positive participants were older, reported greater engagement in sexual risk and injecting drug practices, felt they were at greater risk of acquiring HCV, were less likely to socially and sexually exclude people with HCV and had more positive attitudes towards people who inject drugs and people with HCV compared with HIV-negative and HIV-untested participants. HIV-untested participants ...

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 t...

In this study we sought to identify the social and behavioural characteristics of Australian gay and bisexual men who had and had not tested for HIV during their current relationship. The results were based on 2012 and 2013 data collected from ongoing cross-sectional and community-based surveys held in six Australian states and territories. One thousand five hundred and sixty-one non-HIV-positive men reported that they were in a primary relationship. The majority of gay and bisexual men in primary relationships had tested for HIV during the relationship (73.4 %). Among men who had not tested during the relationship, almost half of these men had never tested for HIV. As untested men within relationships are potentially at risk of acquiring and transmitting HIV to their partners unknowingly, it is important to promote HIV testing to these men.

This report includes findings from a cros-ssectional study of social and behavioural risk factors for syphilis infection and transmission among MSM in Sydney (Part 1), as well as qualitative material on gay men’s understandings and experiences of syphilis and other STIs (Part 2). The cross-sectional study recruited men diagnosed with syphilis from inner Sydney sexual health clinics, inviting them to complete a questionnaire about how they believed they contracted syphilis, their disease knowledge, sexual behaviour and risk practices for onward transmission. The qualitative material on syphilis, STIs and the perception and management of risk is taken from interviews with gay men in Sydney who engage in sexually adventurous sex practices. The results from both studies provide useful information in guiding educational and public health responses to the increase in syphilis among MSM in Sydney.

ABSTRACT In recent years, several studies have suggested that the use of performance and image enhancing drugs via injection is increasing in Australia, with anabolic steroids appearing to be the most commonly used of these drugs. Traditionally the domain of elite athletes and recreational bodybuilders, steroid use may be extending to other groups, including adolescents, gym attendees, professionals and students. Like other forms of injecting drug use, steroid injecting can allow transmission of blood-borne viruses, especially hepatitis C, but little is known about how steroid injecting takes place and how such transmission might occur. Crucially, Australia’s existing harm reduction framework appears ill-equipped to deal with this emerging trend, and is underprepared to meet the challenges that it may pose. In this commentary, we outline key areas where more research into steroid use in Australia is needed. Improved understandings of the practices and experiences of individuals, who inject steroids, and the possibilities for targeted harm reduction responses, are needed if Australia is to respond to the increase in steroid use effectively.

ABSTRACT Gay men are becoming increasingly involved in reproduction despite significant barriers limiting their access to reproductive technologies or legal parentage in many jurisdictions. Based on in-depth interviews with gay men in the United States and Australia who have become parents through surrogacy, I explore how gay men understand their desire to have children and what frames their parenthood experiences. The notion of choice is widespread in understandings of gay parenthood and family formation. Most of the men in this study did not develop a “procreative consciousness” as a result of sexual and fertility-related events. The majority also initially accepted the notion that homosexuality was synonymous with childlessness. Awareness of the possibilities for parenthood emerged over time through the promotional activities of surrogacy agencies, through media, peers, and relationship partners. Additionally, men played with the symbols of kinship to negotiate and obscure biogenetic paternity.

Seeking sexual partners online is associated with sexual risk-taking among men who have sex with men (MSM), but it is not well understood how this use of the Internet is implicated in potential sexual risks. The present study explores whether fantasizing about unprotected anal intercourse (UAI) during online chatting is associated with UAI with partners met online. An online survey of 2058 MSM in France included assessments of UAI with partners met online, responses to erotic chatting about UAI, intentions to use condoms, attitudes regarding UAI, practicing UAI with casual partners, alcohol and drug use with sex and biographical characteristics. While intentions to use condoms with casual partners were high, one-third (32.1%) of respondents reported UAI with partners met online. Responding positively to online chatting about UAI was significantly associated with UAI with partners met online, controlling for intentions, attitudes, behavior and biographic characteristics. These findings suggest that, while MSM may not go online to seek UAI, some engage in online fantasizing about UAI that is associated with possible sexual risk-taking. This speaks critically to the assumption that online fantasizing has no behavioral implications, and underscores the importance of human immunodeficiency virus prevention that addresses the dynamics of online chatting.

... HIV infection is just one of the many salient factors in relationships and that love, intimacy, pleasure, anxiety and closeness, may be just as important in determining agreements and actual sexual practices (Murphy, Ellard et al. ... Adam, BD, (2006). ... Davidovich, U., de Wit, J. et al. ...

Although there is evidence of increasing overall rates of HIV status disclosure among gay and bisexual men, little is
known about men’s disclosure expectations and practices. In this study, we investigate the importance non-HIVpositive
men in Australia vest in knowing the HIV status of their sexual partners, and the extent to which they
restrict sex to partners of the same HIV status, and their HIV disclosure expectations. Data were collected
through a national, online self-report survey. Of the 1044 men included in the study, 914 were HIV negative and
130 were untested. Participants completed the assessment of socio-demographic characteristics, HIV status
preferences, and disclosure expectations and practices. Participants also completed reliable multi-item measures
of perceived risk of HIV transmission, expressed HIV-related stigma, and engagement with the gay community
and the community of people living with HIV. A quarter (25.9%) of participants wanted to know the HIV status
of all sexual partners, and one-third (37.2%) restricted sex to partners of similar HIV status. Three quarters
(76.3%) expected HIV-positive partners to disclosure their HIV status before sex, compared to 41.6% who
expected HIV-negative men to disclose their HIV status. Less than half (41.7%) of participants reported that
they consistently disclosed their HIV status to sexual partners. Multivariate linear regression analysis identified
various covariates of disclosure expectations and practices, in particular of disclosure expectations regarding
HIV-positive men. Men who expected HIV-positive partners to disclose their HIV status before sex more often
lived outside capital cities, were less educated, were less likely to identify as gay, perceived more risk of HIV
transmission from a range of sexual practices, were less engaged with the community of people living with HIV,
and expressed more stigma towards HIV-positive people. These findings suggest that an HIV-status divide is
emerging or already exists among gay men in Australia. HIV-negative and untested men who are most likely to
sexually exclude HIV-positive men are less connected to the HIV epidemic and less educated about HIV risk and
prevention.