Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmi... more Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM). A variety of measures of CLAI have been commonly used in behavioral surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM's sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as "any CLAI" do not accurately measure HIV sexual risk behavior. Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last 6 months were collected, separated by partner type (regular vs. casual) and partners' HIV status (negative, positive, and HIV status unknown). A total of 228,064 episodes of CLA...
Behavioural surveillance and research among gay and other men who have sex with men (GMSM) common... more Behavioural surveillance and research among gay and other men who have sex with men (GMSM) commonly relies on non-random recruitment approaches. Methodological challenges limit their ability to accurately represent the population of adult GMSM. We compared the social and behavioural profiles of GMSM recruited via venue-based, online, and respondent-driven sampling (RDS) and discussed their utility for behavioural surveillance. Data from four studies were selected to reflect each recruitment method. We compared demographic characteristics and the prevalence of key indicators including sexual and HIV testing practices obtained from samples recruited through different methods, and population estimates from respondent-driven sampling partition analysis. Overall, the socio-demographic profile of GMSM was similar across samples, with some differences observed in age and sexual identification. Men recruited through time-location sampling appeared more connected to the gay community, report...
JAIDS Journal of Acquired Immune Deficiency Syndromes
INTRODUCTION In March 2020, Australian state and federal governments introduced physical distanci... more INTRODUCTION In March 2020, Australian state and federal governments introduced physical distancing measures alongside widespread testing to combat COVID-19. These measures may decrease people's sexual contacts and thus reduce the transmission of HIV and other sexually transmissible infections (STIs). We investigated the impact of physical distancing measures due to COVID-19 on the sexual behaviour of gay and bisexual men (GBM) in Australia. METHODS Between April 4 and April 29 2020, 940 participants in an ongoing cohort study responded to questions to measure changes in sexual behaviours during the COVID-19 pandemic. Men reported the date they become concerned about COVID-19, and whether they engaged in sexual behaviour with regular or casual partners or 'fuckbuddies' in the six months prior to becoming concerned about COVID-19 (hereafter referred to as 'before COVID-19'), and following the date they become concerned about COVID-19 (hereafter referred to as 'since COVID-19'). Before and since COVID-19 was based on individual participants' own perceived date of becoming concerned about COVID-19. RESULTS Mean age of was 39.9 years (SD: 13.4). Most participants (88.3%) reported sex with other men during the six months before COVID-19. Of the 587 men (62.4%) who reported sex with casual partners before COVID-19, 93 (15.8%) continued to do so in the period since COVID-19, representing a relative reduction of 84.2%. CONCLUSION GBM in Australia have dramatically reduced their sexual contacts with other men since COVID-19. These behavioural changes will likely result in short-term reductions in new HIV and STI diagnoses. If sexual health screenings are undertaken prior to resuming sexual activity, this could present a novel opportunity to interrupt chains of HIV and STI transmission.
COVID-19 may threaten the already poor mental health outcomes of Australian gay and bisexual men ... more 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.
Culture Health Sexuality an International Journal For Research Intervention and Care, 2015
Responsibility for the practise of (un)safe sex, for taking or not taking risks in relation to HI... more Responsibility for the practise of (un)safe sex, for taking or not taking risks in relation to HIV transmission and for the negotiation of (safe) sex have been concerns in HIV-prevention research for a long time. This paper presents the findings of a discourse analysis of interview texts collected as part of the Three or More Study. We examine what, in the discourse examined, constrains and enables 'response-ability' - the capacity to respond to others and one's self in light of the complex contingencies that operate to enliven sexual contexts. We identify three key aspects of these sexual contexts that impact on response-ability: that there is an absence of 'explicit' (verbally communicated) negotiation and the presence of action-perception links, which are understood as forms of negotiation; that some sexual contexts appear to involve the passivity of participants to the sexual event, interaction or to other men, but that there is agency in and as part of this passivity; and that there exists a social obligation to being individually responsible for sexual decision making, including the taking of risks.
We estimated the size of the population of gay-identified men who have sex with men (gay men) eli... more We estimated the size of the population of gay-identified men who have sex with men (gay men) eligible for PrEP in Australia under the current national PrEP guidelines. Using input indicators from the Australian Bureau of Statistics, the national representative survey Second Australian Study of Health and Relationships, and national HIV- behavioural surveillance, we calculated the size of the population of sexually active gay men and estimated a range for the number eligible for PrEP using different scenarios based on the guidelines. In 2015, an estimated 108,850 sexually-active 16-69-year-old gay men were classified as at risk of acquiring HIV in Australia. Of these men, 10,558 to 30,913 (9.7%-28.4%) were classified as being at high risk and therefore eligible for PrEP, most commonly due to recent receptive condomless intercourse with casual partners (6.1% to 15.5%), STI infections (5.4% to 10.6%) or the use of crystal methamphetamine (1.4% to 9.4%). The higher estimates included m...
The relevance of circumcision in preventing HIV male-to-male sex transmission is poorly understoo... more The relevance of circumcision in preventing HIV male-to-male sex transmission is poorly understood, in particular because any potential effect could be obscured by sexual practice as a mediating or confounding factor. Using data from the Health in Men (HIM) cohort of 1426 HIV-negative homosexually active men in Sydney, we compared the sexual practices and sexual experiences of circumcised and uncircumcised men. Overall 66% of men (n�=�939) in the cohort were circumcised. After adjusting for age and ethnicity, we found no difference between circumcised and uncircumcised men in anal sexual practices, difficulty using condoms, or sexual difficulties (e.g. loss of libido). Among the circumcised men, we compared those circumcised at infancy (n�=�854) with those circumcised after infancy (n�=�81). The majority cited phimosis (i.e., an inability to fully retract the foreskin) and parents' decision as the main reasons for circumcision after infancy. After adjusting for age and ethnicity...
We report prevalence and incidence of drug use initiation in Australian gay and bisexual men (GBM... more We report prevalence and incidence of drug use initiation in Australian gay and bisexual men (GBM) participating in an online cohort study. Between September 2014 and June 2015, 1,710 GBM were enrolled in the Following Lives Undergoing Change Study and followed-up six monthly. Participants were asked about measures of lifetime use at baseline and recent use (last six months) at all visits. Drug use initiation was defined as men who reported having never used a specific drug prior to baseline and reported recent use at follow-up. Participants' median age was 31 years (range: 16-81). Prevalence of lifetime use was significantly associated with older age for all individual drugs (p trend<0.001), and 84.1% reported lifetime use of any drugs. Just above half (51.9%) reported recent use at baseline, with the majority reporting occasional use (once or twice in the previous six-months). Among men who reported no history of drug use at baseline, drug initiation was highest for amyl ni...
Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is... more Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is limited to one published study. We calculated transmission rates in couples reporting condomless anal intercourse (CLAI), when HIV-positive partners were virally suppressed, and daily pre-exposure prophylaxis (PrEP) was not used by HIV-negative partners. In the Opposites Attract observational cohort study, serodiscordant male homosexual couples were recruited from 13 clinics in Australia, one in Brazil, and one in Thailand. At study visits, HIV-negative partners provided information on sexual behaviour and were tested for HIV and sexually transmitted infections; HIV-positive partners had HIV viral load tests, CD4 cell count, and sexually transmitted infection tests done. Viral suppression was defined as less than 200 copies per mL. Linked within-couple HIV transmissions were identified with phylogenetic analysis. Incidence was calculated per couple-year of follow-up, focusing on periods...
Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmi... more Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM). A variety of measures of CLAI have been commonly used in behavioral surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM's sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as "any CLAI" do not accurately measure HIV sexual risk behavior. Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last 6 months were collected, separated by partner type (regular vs. casual) and partners' HIV status (negative, positive, and HIV status unknown). A total of 228,064 episodes of CLA...
Behavioural surveillance and research among gay and other men who have sex with men (GMSM) common... more Behavioural surveillance and research among gay and other men who have sex with men (GMSM) commonly relies on non-random recruitment approaches. Methodological challenges limit their ability to accurately represent the population of adult GMSM. We compared the social and behavioural profiles of GMSM recruited via venue-based, online, and respondent-driven sampling (RDS) and discussed their utility for behavioural surveillance. Data from four studies were selected to reflect each recruitment method. We compared demographic characteristics and the prevalence of key indicators including sexual and HIV testing practices obtained from samples recruited through different methods, and population estimates from respondent-driven sampling partition analysis. Overall, the socio-demographic profile of GMSM was similar across samples, with some differences observed in age and sexual identification. Men recruited through time-location sampling appeared more connected to the gay community, report...
JAIDS Journal of Acquired Immune Deficiency Syndromes
INTRODUCTION In March 2020, Australian state and federal governments introduced physical distanci... more INTRODUCTION In March 2020, Australian state and federal governments introduced physical distancing measures alongside widespread testing to combat COVID-19. These measures may decrease people's sexual contacts and thus reduce the transmission of HIV and other sexually transmissible infections (STIs). We investigated the impact of physical distancing measures due to COVID-19 on the sexual behaviour of gay and bisexual men (GBM) in Australia. METHODS Between April 4 and April 29 2020, 940 participants in an ongoing cohort study responded to questions to measure changes in sexual behaviours during the COVID-19 pandemic. Men reported the date they become concerned about COVID-19, and whether they engaged in sexual behaviour with regular or casual partners or 'fuckbuddies' in the six months prior to becoming concerned about COVID-19 (hereafter referred to as 'before COVID-19'), and following the date they become concerned about COVID-19 (hereafter referred to as 'since COVID-19'). Before and since COVID-19 was based on individual participants' own perceived date of becoming concerned about COVID-19. RESULTS Mean age of was 39.9 years (SD: 13.4). Most participants (88.3%) reported sex with other men during the six months before COVID-19. Of the 587 men (62.4%) who reported sex with casual partners before COVID-19, 93 (15.8%) continued to do so in the period since COVID-19, representing a relative reduction of 84.2%. CONCLUSION GBM in Australia have dramatically reduced their sexual contacts with other men since COVID-19. These behavioural changes will likely result in short-term reductions in new HIV and STI diagnoses. If sexual health screenings are undertaken prior to resuming sexual activity, this could present a novel opportunity to interrupt chains of HIV and STI transmission.
COVID-19 may threaten the already poor mental health outcomes of Australian gay and bisexual men ... more 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.
Culture Health Sexuality an International Journal For Research Intervention and Care, 2015
Responsibility for the practise of (un)safe sex, for taking or not taking risks in relation to HI... more Responsibility for the practise of (un)safe sex, for taking or not taking risks in relation to HIV transmission and for the negotiation of (safe) sex have been concerns in HIV-prevention research for a long time. This paper presents the findings of a discourse analysis of interview texts collected as part of the Three or More Study. We examine what, in the discourse examined, constrains and enables &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;response-ability&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; - the capacity to respond to others and one&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s self in light of the complex contingencies that operate to enliven sexual contexts. We identify three key aspects of these sexual contexts that impact on response-ability: that there is an absence of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;explicit&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (verbally communicated) negotiation and the presence of action-perception links, which are understood as forms of negotiation; that some sexual contexts appear to involve the passivity of participants to the sexual event, interaction or to other men, but that there is agency in and as part of this passivity; and that there exists a social obligation to being individually responsible for sexual decision making, including the taking of risks.
We estimated the size of the population of gay-identified men who have sex with men (gay men) eli... more We estimated the size of the population of gay-identified men who have sex with men (gay men) eligible for PrEP in Australia under the current national PrEP guidelines. Using input indicators from the Australian Bureau of Statistics, the national representative survey Second Australian Study of Health and Relationships, and national HIV- behavioural surveillance, we calculated the size of the population of sexually active gay men and estimated a range for the number eligible for PrEP using different scenarios based on the guidelines. In 2015, an estimated 108,850 sexually-active 16-69-year-old gay men were classified as at risk of acquiring HIV in Australia. Of these men, 10,558 to 30,913 (9.7%-28.4%) were classified as being at high risk and therefore eligible for PrEP, most commonly due to recent receptive condomless intercourse with casual partners (6.1% to 15.5%), STI infections (5.4% to 10.6%) or the use of crystal methamphetamine (1.4% to 9.4%). The higher estimates included m...
The relevance of circumcision in preventing HIV male-to-male sex transmission is poorly understoo... more The relevance of circumcision in preventing HIV male-to-male sex transmission is poorly understood, in particular because any potential effect could be obscured by sexual practice as a mediating or confounding factor. Using data from the Health in Men (HIM) cohort of 1426 HIV-negative homosexually active men in Sydney, we compared the sexual practices and sexual experiences of circumcised and uncircumcised men. Overall 66% of men (n�=�939) in the cohort were circumcised. After adjusting for age and ethnicity, we found no difference between circumcised and uncircumcised men in anal sexual practices, difficulty using condoms, or sexual difficulties (e.g. loss of libido). Among the circumcised men, we compared those circumcised at infancy (n�=�854) with those circumcised after infancy (n�=�81). The majority cited phimosis (i.e., an inability to fully retract the foreskin) and parents' decision as the main reasons for circumcision after infancy. After adjusting for age and ethnicity...
We report prevalence and incidence of drug use initiation in Australian gay and bisexual men (GBM... more We report prevalence and incidence of drug use initiation in Australian gay and bisexual men (GBM) participating in an online cohort study. Between September 2014 and June 2015, 1,710 GBM were enrolled in the Following Lives Undergoing Change Study and followed-up six monthly. Participants were asked about measures of lifetime use at baseline and recent use (last six months) at all visits. Drug use initiation was defined as men who reported having never used a specific drug prior to baseline and reported recent use at follow-up. Participants' median age was 31 years (range: 16-81). Prevalence of lifetime use was significantly associated with older age for all individual drugs (p trend<0.001), and 84.1% reported lifetime use of any drugs. Just above half (51.9%) reported recent use at baseline, with the majority reporting occasional use (once or twice in the previous six-months). Among men who reported no history of drug use at baseline, drug initiation was highest for amyl ni...
Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is... more Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is limited to one published study. We calculated transmission rates in couples reporting condomless anal intercourse (CLAI), when HIV-positive partners were virally suppressed, and daily pre-exposure prophylaxis (PrEP) was not used by HIV-negative partners. In the Opposites Attract observational cohort study, serodiscordant male homosexual couples were recruited from 13 clinics in Australia, one in Brazil, and one in Thailand. At study visits, HIV-negative partners provided information on sexual behaviour and were tested for HIV and sexually transmitted infections; HIV-positive partners had HIV viral load tests, CD4 cell count, and sexually transmitted infection tests done. Viral suppression was defined as less than 200 copies per mL. Linked within-couple HIV transmissions were identified with phylogenetic analysis. Incidence was calculated per couple-year of follow-up, focusing on periods...
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