Dual infection with HIV‐1 and HIV‐2, which is not uncommon in West Africa, has important implicat... more Dual infection with HIV‐1 and HIV‐2, which is not uncommon in West Africa, has important implications for transmission, progression, and antiretroviral therapy. Few studies have examined HIV viral dynamics in this setting.
Background: Expanded access to HIV pre-exposure prophylaxis (PrEP) is being actively debated in A... more Background: Expanded access to HIV pre-exposure prophylaxis (PrEP) is being actively debated in Australia. Awareness and knowledge of this HIV-prevention method have not been assessed in detail in the primary affected population, gay and bisexual men. Methods: Awareness and knowledge of PrEP were assessed among Australian gay and bisexual men, who were asked to complete a national, anonymous, online survey in 2015. Associations with PrEP awareness were identified with multivariate logistic regression and associations with PrEP knowledge were identified using multivariate linear regression. Results: Among 1251 participants, 954 (77%) were aware of PrEP. The most common sources of information were gay community media, Australian websites and friends. Awareness of PrEP was independently associated with older age, living in a capital city, having a university degree, being tested for HIV, being HIV-positive, having condomless anal intercourse with regular male partners, and ever having taken post-exposure prophylaxis. Men in monogamous relationships were less likely to be aware of PrEP. Among men who were aware of PrEP, the mean PrEP knowledge score was 6.8 out of 13. Relatively few participants knew that taking PrEP involved regular clinical monitoring and that in Australia PrEP was only recommended for people at risk of HIV. Better knowledge was independently associated with living in a capital city, having a university degree, being in full-time employment, being HIV-positive, and ever having taken post-exposure prophylaxis or PrEP. Conclusions: To assist in appropriate PrEP uptake, we recommend educating gay and bisexual men about current Australian prescribing guidelines and how PrEP is accessed in Australia.
The study described in this paper is part of a project assessing the impact of the HIV epidemic o... more The study described in this paper is part of a project assessing the impact of the HIV epidemic on 535 men who have sex with men. These men were surveyed about their knowledge of HIV, their sexual practices, other issues concerning the transmission of HIV, and AIDS. This paper focuses on these men's beliefs about HIV transmission, their perceptions of the safety of a number of sexual and social practices, and the factors influencing these perceptions. The findings indicate, in general, that the men surveyed were moderately well informed about HIV transmission. Some twenty percent of the men were well-informed about both 'safe' and 'unsafe' sexual practices, a small number were ill-informed and the remainder, the majority, were wellinformed about some aspects and ill;i(lformed about others. The data suggest that information from the mainstream and gay press is not only differentially available but that information is processed and interpreted by the men in different ways. Variables which influence the manner in which information is interpreted are place of residence (locale), awareness of gay community posters and pamphlets, and the men's sexual practice; these are associated with cautiousness or rashness in the men's judgments of safety and risk. The Social Aspects of the Prevention of AIDS (SAPA) study is a programme of research designed to supply background information for education strategies in HIV IAIDS prevention. Its focus is on the sexual and social lives of gay and bisexual men, the information environment in which they live, their responses to the human immunodeficiency virus (HIV) epidemic, and the impact of strategies designed to change high-risk sexual behaviours. This paper deals with one aspects of that study: the beliefs that gay and bisexual men hold about HIV transmission, the acquired immune deficiency syndrome (AIDS) and safe sex, and the factors which are implicated in the formation of those beliefs and opinions. The data come from Study A in the SAPA programme, a survey of
We assessed interest in using rectal microbicides to prevent HIV transmission among gay men in Au... more We assessed interest in using rectal microbicides to prevent HIV transmission among gay men in Australia. A national online survey was conducted in 2013. Interest in using rectal microbicides was measured on a seven-item scale (α=0.81). Factors independently associated with greater interest in using a microbicide were identified using multivariate logistic regression. Data were collected from 1223 HIV-negative and untested men. Mean age was 31.3 years (SD=10.8, range 18-65); 77% were born in Australia and 25% reported any condomless anal sex with a casual partner in the previous 6 months. Overall, there was moderate interest in using rectal microbicides (M=3.33, range 1-5). In multivariate analysis, greater interest in using microbicides was independently associated with being born outside Australia (adjusted OR (AOR)=1.59; p=0.009), greater self-perceived likelihood of becoming HIV positive (AOR=3.40; p<0.001), less uncertainty about the efficacy of microbicides (AOR=0.65; p=0.0...
Objective: To examine whether there have been recent changes in Australian antiretroviral treatme... more Objective: To examine whether there have been recent changes in Australian antiretroviral treatment (ART) prescribers' perceptions and practices relating to early ART initiation, which was defined as commencing ART when a patient's CD4+ T-cell count approaches 500 cells/mm 3 or immediately after a patient is diagnosed with HIV. Design, participants and setting: Self-completed, anonymous, crosssectional surveys, targeting all ART prescribers in Australia, were conducted online in 2012 and 2013. The surveys included questions on prescriber factors, CD4+ T-cell count at which prescribers would most strongly recommend ART initiation, and perceived patient characteristics that could change prescribers' practices of early initiation of ART. Main outcome measures: Proportions of ART prescribers recommending early ART initiation. Results: We analysed responses from 108 participants in 2012 and 82 participants in 2013. In both years, more male than female prescribers participated. The median age of participants was 49 years in 2012 and 50 years in 2013. In both rounds, over 60% had more than 10 years' experience in treating HIV-positive patients. More prescribers in 2013 stated that they would most strongly recommend early ART initiation compared with those in 2012 (50.0% [95% CI, 38.7%-61.3%] v 26.9% [95% CI, 18.8%-36.2%]; P = 0.001). The prescribers' primary concern was more about individual patient than public health benefit. Out of 824 patients for whom ART was initiated, as reported by prescribers in 2013, only 108 (13.1% [95% CI, 10.9%-15.6%]) were given ART primarily to prevent onward HIV transmission. The number of patients for whom ART was initiated was significantly associated with prescribers' HIV caseload even after adjusting for prescriber type (adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P < 0.001); of the 37 who had initiated ART for 10 or more patients, 29 had a high HIV caseload. In 2013, 60 prescribers (73.2% [95% CI, 62.2%-82.4%]) reported that they routinely recommended ART to treatment-naive, asymptomatic patients with a CD4+ T-cell count of 350-500 cells/mm 3. Conclusion: Our findings show increasing acceptance of and support for early ART initiation primarily as treatment and not as prevention.
The relevance of community in the face of mounting individualism remains a pressing sociological ... more The relevance of community in the face of mounting individualism remains a pressing sociological issue. Social fragmentation challenges traditional communities of shared identifications and collective memberships while flexible relationship options lead sociologists to question the real benefits of friendships and the viability of personal commitments. These issues are sharply defined in current debates about ‘gay community’ and whether sexual practices can generate solidarity among a diversified social group. AIDS educators have long relied on notions of ‘gay community attachment’ and sociologists enthusiastically explore the innovative potential of gay and lesbian friendships for rethinking community today. Drawing evidence from a national e-male survey of the social relationships and sexual behaviour of over 4000 gay and bisexual men, we suggest that community pessimism is exaggerated. We contest unified sexualized notions of (gay) community and identify a potential for solidarit...
Results Among 1427 participants enrolled, 65 study-visit-diagnosed pharyngeal gonorrhoea infectio... more Results Among 1427 participants enrolled, 65 study-visit-diagnosed pharyngeal gonorrhoea infections were identified (incidence 1.51 per 100 person-years, 95% CI 1.19 to 1.93) of which seven infections were identified on baseline testing (prevalence 0.57%, 95% CI 0.23 to ...
Correspondence concerning this article should be addressed to Catherine Waldby, School of Sociolo... more Correspondence concerning this article should be addressed to Catherine Waldby, School of Sociology and Anthropology, University of New South Wales, Sydney 2052, Australia. E-mail: c.waldby@unsw.edu.au; Annette Houlihan, Griffith Law School, Nathan Campus, ...
Background: Rates of newly acquired HIV infection are increasing in Australia, and sexual contact... more Background: Rates of newly acquired HIV infection are increasing in Australia, and sexual contact between men accounts for 85% of cases. Objective: To investigate behavioural risk factors for HIV seroconversion among gay and bisexual men from Sydney and Melbourne, Australia. Methods: 103 men with newly acquired HIV infection were recruited from clinics in Sydney and Melbourne and behavioural risk factor questionnaires were administered between January 2003 and October 2004. Results were compared with a cross sectional and a cohort study performed by our group that enrolled similar populations of men. Results: The majority of seroconverters (73%) reported more than five sexual partners in the last six months. Ninety-five men (92%) were able to identify a high-risk event (HRE) that they thought had led to their HIV seroconversion. Most (70%) reported receptive unprotected anal intercourse (UAI), insertive UAI, or both at their HRE. Sixteen men (16%) reported no UAI in the preceding si...
Background: Syphilis has re-emerged and become established in gay communities in most developed c... more Background: Syphilis has re-emerged and become established in gay communities in most developed countries since the late 1990s. HIV infected men have been disproportionately affected by this endemic, but it is unclear whether this is due to behavioural or biological reasons. We report incidence and risk factors for syphilis in two community-based cohorts of HIV-negative and HIV-positive homosexual men in Sydney, Australia. Methods: Participants were recruited using similar community-based strategies in both cohorts and underwent annual face-to-face interviews. Syphilis screening was offered to all consenting participants at annual visits. Results: In the HIV-negative cohort, 21 men seroconverted to syphilis and one man had a syphilis re-infection during 2001–07, an incidence of 0.49 per 100 person-years (95% CI: 0.31–0.74). In the HIV-positive cohort during 2005–07, eight men seroconverted and one man had a syphilis re-infection, giving an incidence of 3.62 per 100 person-years (95%...
The Australian and New Zealand Journal of Sociology, 1990
Exploring the social dimension of sexuality is crucial to prevention strategies for AIDS. New dev... more Exploring the social dimension of sexuality is crucial to prevention strategies for AIDS. New developments in social theories of sexuality can inform empirical research. A survey of 535 gay and bisexual men in New South Wales and the Australian Capital Territory was designed in the light of practice-based analyses of gender and sexuality. Anal intercourse without condoms ranks high in physical and emotional significance though it is known to be relatively unsafe with regard to transmission of the human immunodeficiency virus. This practice shows few statistical connections to variables describing social structure, but is linked to variables describing gay social milieu attachment, patterns of sexuality, and awareness of the situation created by the AIDS crisis. Potentially dangerous anal practice is more common within established relationships and especially common with men who describe themselves as 'monogamous'. This creates dilemmas for prevention strategy. Connections be...
Introduction. Sexual expression affects physical, mental and social well-being. There is a lack o... more Introduction. Sexual expression affects physical, mental and social well-being. There is a lack of understanding of male sexual dysfunction in homosexually active men. Aim. We investigated gay men's self-report of a number of sexual problems. Methods. The survey data were from a sample of 542 self-identified gay men, 40% of whom were HIV positive, recruited from six high HIV-caseload general practices in Australia. Main Outcome Measures. The reporting of experiencing three or more sexual problems over a period of at least 1 month in the 12 months prior to a survey was defined here as having "multiple" sexual problems. We explored a number of factors, including HIV status, depression, alcohol and other drug use, and sexual risk-taking with casual male partners, in association with multiple sexual problems. Results. Rates of a range of self-reported sexual problems were high, with erectile dysfunction and lack of sexual desire being the most commonly reported. These high rates were consistent with the limited data from previous Australian studies. Men who had multiple sexual problems were likely to suffer from major depression (P < 0.001). A higher proportion of the HIV-positive gay men (48.4%) reported multiple sexual problems than the HIV-negative men (35.1%, P = 0.002). Factors independently associated with multiple sexual problems among the HIV-negative gay men were poorer general health and interpersonal isolation, whereas for the HIV-positive gay men, they were adoption of avoidant strategies to cope with daily life stress, sexual risk-taking in casual encounters, and the use of antidepressants. Conclusions. Our findings underscore the complex interactions between depression, sexual dysfunction, sexual risk taking, HIV infection, and general well-being among homosexually active men. Mao L, Newman CE, Kidd MR, Saltman DC, Rogers GD, and Kippax SC. Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia.
Background. Despite increasing reports of herpes simplex virus (HSV) type 1 (HSV-1)-associated an... more Background. Despite increasing reports of herpes simplex virus (HSV) type 1 (HSV-1)-associated anogenital herpes, there are very limited data comparing the seroepidemiological profile of and risk factors for HSV-1 and HSV type 2 (HSV-2) infection. Methods. Sexual behaviors were examined as risk factors for prevalent and incident HSV-1 and HSV-2 infections in a community-based cohort of 1427 HIV-negative gay men in Australia. Results. The prevalence of HSV-1 and HSV-2 at baseline was 75% and 23%, respectively. The rate of prevalent infection with HSV-1, as well as the rate of prevalent infection with HSV-2, was much lower in individuals !25 years of age, and each type of infection was associated with a higher number of both male and female sex partners. The median duration of follow-up of the cohort was 2.0 years. Among participants who were susceptible to infection, the incidence rates for HSV-1 and HSV-2 infection were 5.58 and 1.45 cases per 100 person-years, respectively. In multivariate analysis, incident infection with HSV-1 was significantly associated with younger age () and reports of frequent insertive oral sex with casual partners (hazard ratio, 3.91 [95% confidence P p .027 interval, 1.23-12.44];). Incident infection with HSV-2 was significantly associated with a variety of anal P p .021 sex practices with casual partners. Conclusions. Both HSV-1 and HSV-2 were commonly sexually transmitted, and there were more HSV-1 than HSV-2 seroconversions. Public-health strategies targeted against anogenital herpes increasingly need to take into account the importance of HSV-1 infection. There are 2 types of herpes simplex virus (HSV): HSV-1 and HSV-2. HSV-1 typically causes oropharyngeal infection, and transmission occurs primarily through personal contact during childhood, although it can also be transmitted sexually. HSV-2 is mainly associated with genital disease, and transmission is usually sexual [1]. Both viruses can cause either anogenital or oropharyngeal infection [2]. Recently, a change in the relative contribution of HSV-1 and HSV-2 to anogenital herpes has been noted.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2007
A range of HIV risk reduction strategies has been described in homosexual men who practice unprot... more A range of HIV risk reduction strategies has been described in homosexual men who practice unprotected anal intercourse (UAI), including serosorting, strategic positioning, and negotiating around an HIV-positive partner&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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s viral load. It is uncertain how commonly these behaviors might result in HIV infection. We describe sexual behaviors and associated risk reduction strategies reported by homosexual men in their accounts of their recent seroconversion. Homosexual men recently diagnosed with primary HIV infection between 2003 and 2006 were invited to participate in a nurse-administered survey. Among 158 men enrolled, 143 (91%) were able to identify the high-risk event that they believed led to their HIV seroconversion, and this involved UAI in 102 (71%). Among these 102 men, 21 (21%) reported they were certain that the source partner was HIV-negative. Ten men (10%) reported insertive UAI as the highest risk behavior. Of the 21 men who reported knowing the HIV-positive partner&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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s viral load, 9 reported that the man had an undetectable viral load (43%). In 38% of the high-risk events involving UAI, infection occurred when the reported risk event involved serosorting, strategic positioning, or intercourse with a man whose viral load was believed to be undetectable.
Background. In contrast to the broad literature on depression in the general population, little i... more Background. In contrast to the broad literature on depression in the general population, little is known about the management of depression affecting gay men and HIV-positive men attending general practice clinics. Objective. This paper explores qualitative descriptions of how depression in gay men and HIVpositive men is managed by GPs. Methods. As part of the qualitative component of a mixed method study on HIV and depression, semi-structured interviews were conducted with 16 GPs in three geographical settings in Australia: Sydney, Adelaide and a rural coastal town. Results. GPs identified a range of features in their experience of managing depression in gay men and in HIV-positive men. Some were common to the care of other groups with depression, but this paper reports on features unique to this patient group. These include capitalizing on the high frequency of contact with this patient group, taking advantage of the specialist multidisciplinary teams who provide support, building upon the unusual willingness of this patient group to take medication, appreciating the central importance to many gay men of sexual functioning, and recreational drug use, responding to social isolation in this patient group and coping with increasing challenges for the HIV general practice workforce. Conclusions. Despite the identification of several key strengths in working with this patient group, the ability of GPs to develop their capacity to manage depression in gay men and men with HIV is uncertain in the context of a growing range of challenges for GPs in both mental health and HIV care.
Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies tha... more Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies that gay men have devised to manage (as distinct from eliminate) risk of HIV transmission. Apart from negotiated safety and positive-positive sex, which have been practised for some ...
Background: HIV has become a chronic manageable infection in the developed world, and early and l... more Background: HIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine. Methods: As part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings. Results: The rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the 'coalface' and the 'cutting edge', and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change. Conclusions: Approaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce.
Australian and New Zealand Journal of Public Health, 2009
ajor depression, an affective disorder, is often triggered by stressful life events. 1 For gay me... more ajor depression, an affective disorder, is often triggered by stressful life events. 1 For gay men, societal factors such as homophobia and grief associated with HIV-related bereavement have been identified as sources of stress. 2-4 People living with HIV encounter specific stressors such as recent HIV-diagnosis, disease progression and HIV-related stigma. 5-7 High rates of depression (17%-30%) have been observed among gay men with and without HIV and a range of associated factors such as non-gay self-identification,
Grunseit, A., Lupton, D., Crawford, J., Kippax, S. and Noble, J. (1995) The country versus the ci... more Grunseit, A., Lupton, D., Crawford, J., Kippax, S. and Noble, J. (1995) The country versus the city: Differences between rural and urban tertiary students on HIV/AIDS knowledge, beliefs and attitudes. Australian Journal of Social Issues, 30, (4), 389-404. ... Full text not available from this repository. ... RDF+N-Triples, RDF+N3, RDF+XML, Browse.
Dual infection with HIV‐1 and HIV‐2, which is not uncommon in West Africa, has important implicat... more Dual infection with HIV‐1 and HIV‐2, which is not uncommon in West Africa, has important implications for transmission, progression, and antiretroviral therapy. Few studies have examined HIV viral dynamics in this setting.
Background: Expanded access to HIV pre-exposure prophylaxis (PrEP) is being actively debated in A... more Background: Expanded access to HIV pre-exposure prophylaxis (PrEP) is being actively debated in Australia. Awareness and knowledge of this HIV-prevention method have not been assessed in detail in the primary affected population, gay and bisexual men. Methods: Awareness and knowledge of PrEP were assessed among Australian gay and bisexual men, who were asked to complete a national, anonymous, online survey in 2015. Associations with PrEP awareness were identified with multivariate logistic regression and associations with PrEP knowledge were identified using multivariate linear regression. Results: Among 1251 participants, 954 (77%) were aware of PrEP. The most common sources of information were gay community media, Australian websites and friends. Awareness of PrEP was independently associated with older age, living in a capital city, having a university degree, being tested for HIV, being HIV-positive, having condomless anal intercourse with regular male partners, and ever having taken post-exposure prophylaxis. Men in monogamous relationships were less likely to be aware of PrEP. Among men who were aware of PrEP, the mean PrEP knowledge score was 6.8 out of 13. Relatively few participants knew that taking PrEP involved regular clinical monitoring and that in Australia PrEP was only recommended for people at risk of HIV. Better knowledge was independently associated with living in a capital city, having a university degree, being in full-time employment, being HIV-positive, and ever having taken post-exposure prophylaxis or PrEP. Conclusions: To assist in appropriate PrEP uptake, we recommend educating gay and bisexual men about current Australian prescribing guidelines and how PrEP is accessed in Australia.
The study described in this paper is part of a project assessing the impact of the HIV epidemic o... more The study described in this paper is part of a project assessing the impact of the HIV epidemic on 535 men who have sex with men. These men were surveyed about their knowledge of HIV, their sexual practices, other issues concerning the transmission of HIV, and AIDS. This paper focuses on these men's beliefs about HIV transmission, their perceptions of the safety of a number of sexual and social practices, and the factors influencing these perceptions. The findings indicate, in general, that the men surveyed were moderately well informed about HIV transmission. Some twenty percent of the men were well-informed about both 'safe' and 'unsafe' sexual practices, a small number were ill-informed and the remainder, the majority, were wellinformed about some aspects and ill;i(lformed about others. The data suggest that information from the mainstream and gay press is not only differentially available but that information is processed and interpreted by the men in different ways. Variables which influence the manner in which information is interpreted are place of residence (locale), awareness of gay community posters and pamphlets, and the men's sexual practice; these are associated with cautiousness or rashness in the men's judgments of safety and risk. The Social Aspects of the Prevention of AIDS (SAPA) study is a programme of research designed to supply background information for education strategies in HIV IAIDS prevention. Its focus is on the sexual and social lives of gay and bisexual men, the information environment in which they live, their responses to the human immunodeficiency virus (HIV) epidemic, and the impact of strategies designed to change high-risk sexual behaviours. This paper deals with one aspects of that study: the beliefs that gay and bisexual men hold about HIV transmission, the acquired immune deficiency syndrome (AIDS) and safe sex, and the factors which are implicated in the formation of those beliefs and opinions. The data come from Study A in the SAPA programme, a survey of
We assessed interest in using rectal microbicides to prevent HIV transmission among gay men in Au... more We assessed interest in using rectal microbicides to prevent HIV transmission among gay men in Australia. A national online survey was conducted in 2013. Interest in using rectal microbicides was measured on a seven-item scale (α=0.81). Factors independently associated with greater interest in using a microbicide were identified using multivariate logistic regression. Data were collected from 1223 HIV-negative and untested men. Mean age was 31.3 years (SD=10.8, range 18-65); 77% were born in Australia and 25% reported any condomless anal sex with a casual partner in the previous 6 months. Overall, there was moderate interest in using rectal microbicides (M=3.33, range 1-5). In multivariate analysis, greater interest in using microbicides was independently associated with being born outside Australia (adjusted OR (AOR)=1.59; p=0.009), greater self-perceived likelihood of becoming HIV positive (AOR=3.40; p<0.001), less uncertainty about the efficacy of microbicides (AOR=0.65; p=0.0...
Objective: To examine whether there have been recent changes in Australian antiretroviral treatme... more Objective: To examine whether there have been recent changes in Australian antiretroviral treatment (ART) prescribers' perceptions and practices relating to early ART initiation, which was defined as commencing ART when a patient's CD4+ T-cell count approaches 500 cells/mm 3 or immediately after a patient is diagnosed with HIV. Design, participants and setting: Self-completed, anonymous, crosssectional surveys, targeting all ART prescribers in Australia, were conducted online in 2012 and 2013. The surveys included questions on prescriber factors, CD4+ T-cell count at which prescribers would most strongly recommend ART initiation, and perceived patient characteristics that could change prescribers' practices of early initiation of ART. Main outcome measures: Proportions of ART prescribers recommending early ART initiation. Results: We analysed responses from 108 participants in 2012 and 82 participants in 2013. In both years, more male than female prescribers participated. The median age of participants was 49 years in 2012 and 50 years in 2013. In both rounds, over 60% had more than 10 years' experience in treating HIV-positive patients. More prescribers in 2013 stated that they would most strongly recommend early ART initiation compared with those in 2012 (50.0% [95% CI, 38.7%-61.3%] v 26.9% [95% CI, 18.8%-36.2%]; P = 0.001). The prescribers' primary concern was more about individual patient than public health benefit. Out of 824 patients for whom ART was initiated, as reported by prescribers in 2013, only 108 (13.1% [95% CI, 10.9%-15.6%]) were given ART primarily to prevent onward HIV transmission. The number of patients for whom ART was initiated was significantly associated with prescribers' HIV caseload even after adjusting for prescriber type (adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P < 0.001); of the 37 who had initiated ART for 10 or more patients, 29 had a high HIV caseload. In 2013, 60 prescribers (73.2% [95% CI, 62.2%-82.4%]) reported that they routinely recommended ART to treatment-naive, asymptomatic patients with a CD4+ T-cell count of 350-500 cells/mm 3. Conclusion: Our findings show increasing acceptance of and support for early ART initiation primarily as treatment and not as prevention.
The relevance of community in the face of mounting individualism remains a pressing sociological ... more The relevance of community in the face of mounting individualism remains a pressing sociological issue. Social fragmentation challenges traditional communities of shared identifications and collective memberships while flexible relationship options lead sociologists to question the real benefits of friendships and the viability of personal commitments. These issues are sharply defined in current debates about ‘gay community’ and whether sexual practices can generate solidarity among a diversified social group. AIDS educators have long relied on notions of ‘gay community attachment’ and sociologists enthusiastically explore the innovative potential of gay and lesbian friendships for rethinking community today. Drawing evidence from a national e-male survey of the social relationships and sexual behaviour of over 4000 gay and bisexual men, we suggest that community pessimism is exaggerated. We contest unified sexualized notions of (gay) community and identify a potential for solidarit...
Results Among 1427 participants enrolled, 65 study-visit-diagnosed pharyngeal gonorrhoea infectio... more Results Among 1427 participants enrolled, 65 study-visit-diagnosed pharyngeal gonorrhoea infections were identified (incidence 1.51 per 100 person-years, 95% CI 1.19 to 1.93) of which seven infections were identified on baseline testing (prevalence 0.57%, 95% CI 0.23 to ...
Correspondence concerning this article should be addressed to Catherine Waldby, School of Sociolo... more Correspondence concerning this article should be addressed to Catherine Waldby, School of Sociology and Anthropology, University of New South Wales, Sydney 2052, Australia. E-mail: c.waldby@unsw.edu.au; Annette Houlihan, Griffith Law School, Nathan Campus, ...
Background: Rates of newly acquired HIV infection are increasing in Australia, and sexual contact... more Background: Rates of newly acquired HIV infection are increasing in Australia, and sexual contact between men accounts for 85% of cases. Objective: To investigate behavioural risk factors for HIV seroconversion among gay and bisexual men from Sydney and Melbourne, Australia. Methods: 103 men with newly acquired HIV infection were recruited from clinics in Sydney and Melbourne and behavioural risk factor questionnaires were administered between January 2003 and October 2004. Results were compared with a cross sectional and a cohort study performed by our group that enrolled similar populations of men. Results: The majority of seroconverters (73%) reported more than five sexual partners in the last six months. Ninety-five men (92%) were able to identify a high-risk event (HRE) that they thought had led to their HIV seroconversion. Most (70%) reported receptive unprotected anal intercourse (UAI), insertive UAI, or both at their HRE. Sixteen men (16%) reported no UAI in the preceding si...
Background: Syphilis has re-emerged and become established in gay communities in most developed c... more Background: Syphilis has re-emerged and become established in gay communities in most developed countries since the late 1990s. HIV infected men have been disproportionately affected by this endemic, but it is unclear whether this is due to behavioural or biological reasons. We report incidence and risk factors for syphilis in two community-based cohorts of HIV-negative and HIV-positive homosexual men in Sydney, Australia. Methods: Participants were recruited using similar community-based strategies in both cohorts and underwent annual face-to-face interviews. Syphilis screening was offered to all consenting participants at annual visits. Results: In the HIV-negative cohort, 21 men seroconverted to syphilis and one man had a syphilis re-infection during 2001–07, an incidence of 0.49 per 100 person-years (95% CI: 0.31–0.74). In the HIV-positive cohort during 2005–07, eight men seroconverted and one man had a syphilis re-infection, giving an incidence of 3.62 per 100 person-years (95%...
The Australian and New Zealand Journal of Sociology, 1990
Exploring the social dimension of sexuality is crucial to prevention strategies for AIDS. New dev... more Exploring the social dimension of sexuality is crucial to prevention strategies for AIDS. New developments in social theories of sexuality can inform empirical research. A survey of 535 gay and bisexual men in New South Wales and the Australian Capital Territory was designed in the light of practice-based analyses of gender and sexuality. Anal intercourse without condoms ranks high in physical and emotional significance though it is known to be relatively unsafe with regard to transmission of the human immunodeficiency virus. This practice shows few statistical connections to variables describing social structure, but is linked to variables describing gay social milieu attachment, patterns of sexuality, and awareness of the situation created by the AIDS crisis. Potentially dangerous anal practice is more common within established relationships and especially common with men who describe themselves as 'monogamous'. This creates dilemmas for prevention strategy. Connections be...
Introduction. Sexual expression affects physical, mental and social well-being. There is a lack o... more Introduction. Sexual expression affects physical, mental and social well-being. There is a lack of understanding of male sexual dysfunction in homosexually active men. Aim. We investigated gay men's self-report of a number of sexual problems. Methods. The survey data were from a sample of 542 self-identified gay men, 40% of whom were HIV positive, recruited from six high HIV-caseload general practices in Australia. Main Outcome Measures. The reporting of experiencing three or more sexual problems over a period of at least 1 month in the 12 months prior to a survey was defined here as having "multiple" sexual problems. We explored a number of factors, including HIV status, depression, alcohol and other drug use, and sexual risk-taking with casual male partners, in association with multiple sexual problems. Results. Rates of a range of self-reported sexual problems were high, with erectile dysfunction and lack of sexual desire being the most commonly reported. These high rates were consistent with the limited data from previous Australian studies. Men who had multiple sexual problems were likely to suffer from major depression (P < 0.001). A higher proportion of the HIV-positive gay men (48.4%) reported multiple sexual problems than the HIV-negative men (35.1%, P = 0.002). Factors independently associated with multiple sexual problems among the HIV-negative gay men were poorer general health and interpersonal isolation, whereas for the HIV-positive gay men, they were adoption of avoidant strategies to cope with daily life stress, sexual risk-taking in casual encounters, and the use of antidepressants. Conclusions. Our findings underscore the complex interactions between depression, sexual dysfunction, sexual risk taking, HIV infection, and general well-being among homosexually active men. Mao L, Newman CE, Kidd MR, Saltman DC, Rogers GD, and Kippax SC. Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia.
Background. Despite increasing reports of herpes simplex virus (HSV) type 1 (HSV-1)-associated an... more Background. Despite increasing reports of herpes simplex virus (HSV) type 1 (HSV-1)-associated anogenital herpes, there are very limited data comparing the seroepidemiological profile of and risk factors for HSV-1 and HSV type 2 (HSV-2) infection. Methods. Sexual behaviors were examined as risk factors for prevalent and incident HSV-1 and HSV-2 infections in a community-based cohort of 1427 HIV-negative gay men in Australia. Results. The prevalence of HSV-1 and HSV-2 at baseline was 75% and 23%, respectively. The rate of prevalent infection with HSV-1, as well as the rate of prevalent infection with HSV-2, was much lower in individuals !25 years of age, and each type of infection was associated with a higher number of both male and female sex partners. The median duration of follow-up of the cohort was 2.0 years. Among participants who were susceptible to infection, the incidence rates for HSV-1 and HSV-2 infection were 5.58 and 1.45 cases per 100 person-years, respectively. In multivariate analysis, incident infection with HSV-1 was significantly associated with younger age () and reports of frequent insertive oral sex with casual partners (hazard ratio, 3.91 [95% confidence P p .027 interval, 1.23-12.44];). Incident infection with HSV-2 was significantly associated with a variety of anal P p .021 sex practices with casual partners. Conclusions. Both HSV-1 and HSV-2 were commonly sexually transmitted, and there were more HSV-1 than HSV-2 seroconversions. Public-health strategies targeted against anogenital herpes increasingly need to take into account the importance of HSV-1 infection. There are 2 types of herpes simplex virus (HSV): HSV-1 and HSV-2. HSV-1 typically causes oropharyngeal infection, and transmission occurs primarily through personal contact during childhood, although it can also be transmitted sexually. HSV-2 is mainly associated with genital disease, and transmission is usually sexual [1]. Both viruses can cause either anogenital or oropharyngeal infection [2]. Recently, a change in the relative contribution of HSV-1 and HSV-2 to anogenital herpes has been noted.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2007
A range of HIV risk reduction strategies has been described in homosexual men who practice unprot... more A range of HIV risk reduction strategies has been described in homosexual men who practice unprotected anal intercourse (UAI), including serosorting, strategic positioning, and negotiating around an HIV-positive partner&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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s viral load. It is uncertain how commonly these behaviors might result in HIV infection. We describe sexual behaviors and associated risk reduction strategies reported by homosexual men in their accounts of their recent seroconversion. Homosexual men recently diagnosed with primary HIV infection between 2003 and 2006 were invited to participate in a nurse-administered survey. Among 158 men enrolled, 143 (91%) were able to identify the high-risk event that they believed led to their HIV seroconversion, and this involved UAI in 102 (71%). Among these 102 men, 21 (21%) reported they were certain that the source partner was HIV-negative. Ten men (10%) reported insertive UAI as the highest risk behavior. Of the 21 men who reported knowing the HIV-positive partner&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;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s viral load, 9 reported that the man had an undetectable viral load (43%). In 38% of the high-risk events involving UAI, infection occurred when the reported risk event involved serosorting, strategic positioning, or intercourse with a man whose viral load was believed to be undetectable.
Background. In contrast to the broad literature on depression in the general population, little i... more Background. In contrast to the broad literature on depression in the general population, little is known about the management of depression affecting gay men and HIV-positive men attending general practice clinics. Objective. This paper explores qualitative descriptions of how depression in gay men and HIVpositive men is managed by GPs. Methods. As part of the qualitative component of a mixed method study on HIV and depression, semi-structured interviews were conducted with 16 GPs in three geographical settings in Australia: Sydney, Adelaide and a rural coastal town. Results. GPs identified a range of features in their experience of managing depression in gay men and in HIV-positive men. Some were common to the care of other groups with depression, but this paper reports on features unique to this patient group. These include capitalizing on the high frequency of contact with this patient group, taking advantage of the specialist multidisciplinary teams who provide support, building upon the unusual willingness of this patient group to take medication, appreciating the central importance to many gay men of sexual functioning, and recreational drug use, responding to social isolation in this patient group and coping with increasing challenges for the HIV general practice workforce. Conclusions. Despite the identification of several key strengths in working with this patient group, the ability of GPs to develop their capacity to manage depression in gay men and men with HIV is uncertain in the context of a growing range of challenges for GPs in both mental health and HIV care.
Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies tha... more Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies that gay men have devised to manage (as distinct from eliminate) risk of HIV transmission. Apart from negotiated safety and positive-positive sex, which have been practised for some ...
Background: HIV has become a chronic manageable infection in the developed world, and early and l... more Background: HIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine. Methods: As part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings. Results: The rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the 'coalface' and the 'cutting edge', and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change. Conclusions: Approaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce.
Australian and New Zealand Journal of Public Health, 2009
ajor depression, an affective disorder, is often triggered by stressful life events. 1 For gay me... more ajor depression, an affective disorder, is often triggered by stressful life events. 1 For gay men, societal factors such as homophobia and grief associated with HIV-related bereavement have been identified as sources of stress. 2-4 People living with HIV encounter specific stressors such as recent HIV-diagnosis, disease progression and HIV-related stigma. 5-7 High rates of depression (17%-30%) have been observed among gay men with and without HIV and a range of associated factors such as non-gay self-identification,
Grunseit, A., Lupton, D., Crawford, J., Kippax, S. and Noble, J. (1995) The country versus the ci... more Grunseit, A., Lupton, D., Crawford, J., Kippax, S. and Noble, J. (1995) The country versus the city: Differences between rural and urban tertiary students on HIV/AIDS knowledge, beliefs and attitudes. Australian Journal of Social Issues, 30, (4), 389-404. ... Full text not available from this repository. ... RDF+N-Triples, RDF+N3, RDF+XML, Browse.
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Papers by Susan Kippax