Jack Bradley has lived and worked in Australia since 2000. He has worked at NCHECR with Garrett Prestage since 2002 as a Projects Officer and Research Assistant, as well as conducting both qualitative and quantitative interviews for a wide range of studies. Jack has worked as a qualitative and/or quantitative interviewer on the HIM (Health in Men) Study, PH (Positive Health) Study, TOM (Three or More) Study, PASH (Pleasure and Sexual Health) Study, and the Online Seroconversion Study.
Abstract: : Measures of HIV treatments optimism were developed in response to increased risk behavior among gay men, but were limited in their capacity to help understand gay men's risk behavior.
Abstract: : Human immunodeficiency virus (HIV) seroadaptive behaviors, such as serosorting and strategic positioning, are being increasingly practised by homosexual men; however, their impact on sexually transmissible infections is unclear.
Abstract: Reducing rates of partner change and increasing condom usage among gay men are obvious targets for potentially reducing syphilis transmission among gay men.
Abstract: Unprotected anal intercourse with casual partners (UAIC) is the strongest predictor of HIV incidence among gay men. Familiarity between sex partners has been associated with likelihood to engage in UAIC, but the decision to use condoms with partners who are previously acquainted is complex and multifaceted. Using data from the Pleasure and Sexual Health survey 2009, we investigated the association between aspects of familiarity with casual partners and disclosure of HIV serostatus. Compared with occasions when they engaged in protected anal intercourse (PAIC), when men engaged in UAIC they were more likely to report having previously met their partners (PAIC 45.9%; UAIC 54.9%), knowing them very well (PAIC 7.9%; UAIC 19.7%), and having previously had sex with them (PAIC 32.2%; UAIC 44.8%) (McNemar PÂ <Â 0.001). Men were also more likely to disclose their HIV serostatus to their casual partners on occasions of UAIC, were more confident they knew their partner's HIV serostatus and trusted them more. Overall, UAIC was associated with both the broad concept of 'familiarity' (composed of elements of prior acquaintance and trust) and HIV disclosure. When men engage in UAIC without some prior familiarity, disclosure of HIV serostatus, or confidence and trust in their partners, they are probably at greater risk than on occasions when they engage in UAIC with partners with whom they do have these qualities. However, for some men, their trust in knowing specific details about their partners may not always be well-informed or reliable. These different circumstances are challenging for HIV prevention work.
Abstract: In Australia, HIV is concentrated in men who have sex with men (MSM) and rates have increased steadily over the past ten years. Health promotion strategies should ideally be informed by an understanding of both the prevalence of the factors being modified, as well as the size of the risk that they confer. We undertook an analysis of the potential population impact and cost saving that would likely result from modifying key HIV risk factors among men who have sex with men (MSM) in Sydney, Australia.
Abstract: The community at which public health strategies for reducing syphilis epidemics are potentially targeted may have different considerations with regards to their sexual and health priorities. We aimed to elicit information on the acceptability of behavior change interventions among gay men for reducing syphilis transmission.
Abstract: Australia has experienced rising notifications of HIV diagnoses despite widely available combination antiretroviral therapy (CART). New HIV diagnoses have also been younger than the average age of those living with HIV. We investigated the degree to which several risk factors could explain this rise in notifications and the younger age profile.
Abstract: Three decades into the HIV epidemic and with the advancement of HIV treatments, condom and non-condom-based anal intercourse among gay men in resource-rich countries needs to be re-assessed.
Abstract: The Australian HIV and sexually transmissible infection (STI) behavioural surveillance system (the repeated cross-sectional Gay Community Periodic Surveys, GCPS) has been conducted since 1998 and covers six main Australian jurisdictions. In this paper, we review its history and methodology, and the available indicators, their trends and their use.
Abstract: Health in Men (HIM) was an open cohort study of 1,427 HIV-negative homosexual men in Sydney. The majority of respondents' unprotected anal intercourse (UAIC) events were with partners whose HIV status they did not know. Nonetheless, with casual partners with whom they engaged in UAIC, respondents indicated that they knew 'well' 28.9% of the HIV-negative partners and 26.2% of HIV-positive partners, but only 7.6% of the HIV status unknown partners. Respondents were more likely to have engaged in UAIC with partners they knew well (McNemar PÂ <Â 0.001). The challenge for HIV prevention is that many gay men's decisions about condom use may be driven as much by their relationship with individual partners as their commitment to 'safe sex'.
Abstract: Gay men who request nonoccupational postexposure prophylaxis (PEP) may seek preexposure prophylaxis (PrEP) should this become available. We explored trends and predictors of PEP use among Australian gay men to inform future biomedical prevention programs.
Abstract: Successful antiretroviral treatments, achievements in gay acceptance and human rights, and internet use have prompted changes in gay socialising which create potential challenges for engaging with gay men for HIV surveillance and research. We used data from the Australian behavioural surveillance and explored (i) the relationship between community engagement and HIV related practices, and (ii) time trends in gay men's engagement with the gay community. Analyses were conducted using log-binomial regression and chi-square test for trend. The proportion of men who socialized mainly with gay men declined and the Internet use to connect with sex partners increased over time. Gay social engagement was associated with HIV positive serostatus, unprotected anal intercourse with regular partners and a high frequency of HIV/STI testing. Our findings indicate a shift in how gay men socialise and find partners. We discuss the challenges for ongoing engagement with gay men for behavioural surveillance and HIV research.
Abstract: Lymphogranuloma venereum (LGV) typing was performed on chlamydia-positive samples obtained in Sydney, Australia, between 2005 and 2007, from community-based cohorts of predominantly asymptomatic HIV-infected and -uninfected men who have sex with men. The number of chlamydia tests and follow-up for each cohort were as follows: 2082 (90.2% of eligible visits) over 2005.1 person-years (PY) of follow-up in the HIV-uninfected cohort; and 521 (70.8% of eligible visits) over 320.2 PY of follow-up in the HIV-infected cohort. One case of rectal LGV in a symptomatic HIV-infected participant was identified among 64 Chlamydia trachomatis infections, giving an LGV incidence in the HIV-infected cohort of 0.3 per 100 PY, 95% Confidence Interval 0.008-1.7. Routine LGV typing of chlamydia infections in asymptomatic Australian men who have sex with men does not appear justified.
Abstract: Group sex is relatively common among gay men, and is a likely risk factor for infection with HIV and other sexually transmissible infections (STI). The 5,432 participants in the 2008 Gay Community Periodic Survey in Sydney, Melbourne and Brisbane, Australia, were asked about their participation in group sex. Nearly half (44.0%) of those who reported sex with casual male partners in the previous 6Â months also reported engaging in group sex. Among other factors, using drugs odds ratios (OR) and confidence intervals (CI) (ORÂ =Â 1.89, CIÂ =Â 1.61-2.21), being HIV-positive (ORÂ =Â 1.62, CIÂ =Â 1.13-2.32), and engaging in anal intercourse, both with a condom (ORÂ =Â 3.03, CIÂ =Â 2.46-3.73) and without a condom (ORÂ =Â 5.68, CIÂ =Â 4.53-7.12) were independently associated with having engaged in group sex. This study suggests that gay men who engage in group sex represent an important priority for targeted HIV and STI prevention activities and research.
Abstract: Familiarity with and a history of prior sex with casual partners is associated with unprotected anal intercourse and may increase the risk of HIV transmission among gay men. Using data from the Sydney Gay Community Periodic Survey 2007, we explored the relationship between familiarity and unprotected anal intercourse with the last casual partner (UAI-LC). 51% of the men knew their last casual partner and 49% had previously had sex with him. Men were more inclined to engage in UAI-LC if they had previously had sex with this partner. HIV-negative men were more likely to have UAI-LC with a more familiar partner independent of his serostatus. Familiarity with and a previous history of sex between casual partners may result in a false sense of trust and may increase the risk of HIV transmission. HIV prevention services should address this issue and develop programs to improve men's skills in negotiating safer sex.
Abstract: 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.
Abstract: Over the last decade, syphilis epidemics have resurged around the world, particularly among gay men. An innovative public health response could be the use of chemoprophylaxis. We sought out to determine the acceptability of syphilis chemoprophylaxis and its likely population effectiveness if it were adopted.
Abstract: We examined a range of common bacterial and viral sexually transmitted infections as risk factors for HIV seroconversion in a community-based cohort of HIV-negative homosexual men in Sydney, Australia.
Abstract: While the HIV epidemic is resurging in gay communities worldwide, HIV notification rates remain stable in NSW. This outcome demonstrates the success of a well-funded partnership approach to preventing HIV infection in gay men in NSW. However, population rates of new diagnoses of HIV are similar to those seen in comparable countries and sexual risk-taking may be increasing. As the HIV epidemic has evolved, prevention in gay men has become more complex and must effectively engage with an increasing diversity of risk reduction strategies. These strategies reflect the continual adaptation of the gay community to evolving understandings of the HIV epidemic and the diverse ways in which gay men balance pleasure and prevention.
Abstract: Data from HIV and behavioural surveillance among gay men in Eastern Australian states in 1994-2008 showed a close relationship between trends in reported unprotected anal intercourse with casual partners (UAIC; measured in behavioural surveys) and routinely reported HIV diagnoses. Increasing UAIC was strongly associated with increasing numbers of HIV diagnoses 2 years later (P = 0.001). This suggests an important public health role of UAIC as a predictor of changes in HIV diagnoses in Australia.
Abstract: Serosorting, the practice of seeking to engage in unprotected anal intercourse with partners of the same HIV status as oneself, has been increasing among men who have sex with men. However, the effectiveness of serosorting as a strategy to reduce HIV risk is unclear, especially since it depends on the frequency of HIV testing.
Abstract: Dental dams are distributed and promoted in some safer sex campaigns for use in oral sex. However, whether and how often dams are used for sex between Australian women remains unknown. We investigated the use of dental dams for sex by lesbians and other women who have sex with women, and the relationship between dam use and sexual risk for this group. In 2004, a self-completion questionnaire was distributed to women attending the Sydney Gay and Lesbian Mardi Gras Fair Day and lesbian community venues and health services in Sydney (n = 543). Among the 330 women who had had oral sex with a woman in the previous 6 months, 9.7% had used a dental dam and 2.1% had used one 'often'. There was little evidence of dam use for prevention of sexually transmissible infections. Although women who practised rimming (oral-anal contact) or had fetish sex involving blood were more likely to have used a dam, dam use was not significantly more common among women who had more partners, or had casual or group sex. Some women avoided oral sex during menstruation or had oral sex with a tampon in place. Latex gloves and condoms were used by more women and more often than dams.
Abstract: The aim of the study was to assess whether subpopulations with sufficiently high HIV incidences for HIV prevention trials can be identified in low HIV incidence settings such as Australia.
Abstract: The aim of the study was to explore the awareness of rectal microbicides, the use of pre-exposure prophylaxis (PREP) and the willingness to participate in biomedical HIV prevention trials in a cohort of HIV-negative gay men.
Abstract: The objective of this study is to estimate per-contact probability of HIV transmission in homosexual men due to unprotected anal intercourse (UAI) in the era of HAART.
Abstract: An increasing incidence of hepatitis C virus (HCV) infection in HIV-positive homosexual men has recently been described, but it is uncertain to what extent this reflects sexual transmission. We report prevalence, incidence and risk factors for HCV infection in community-based cohorts of HIV-negative and HIV-positive homosexual men in Sydney.
Abstract: Prevalence of unprotected anal intercourse between casual male partners (UAIC) has been increasing worldwide. We explored trends in serodiscordant UAIC and the associated factors among gay men in Sydney. Proportions of HIV-positive and negative men with serodiscordant casual partners increased during 2003-2006. Prevalence of serodiscordant UAIC increased among HIV-negative men. Age, number of partners, seeking partners online, drug use and esoteric practices were associated with serodiscordant UAIC. Increases in serodiscordant UAIC may be related to growing disclosure. These findings do not indicate a core group of high-risk men. More research is needed about the context in which serodiscordant UAIC happens.
Abstract: A range of risk reduction behaviours in which homosexual men practise unprotected anal intercourse (UAI) has been described. We aimed to assess the extent of any reduction in HIV risk associated with these behaviours.
Abstract: Among 746 participants in the Three or More Study (TOMS) of gay men who engaged in group sex in the previous 6 months, 22.4% reported unprotected anal intercourse (UAI) with any partners they did not know to be the same HIV serostatus as themselves. Not knowing oneself to be HIV-negative, not having a clear intention to use condoms, and more frequent group sex were independently associated with UAI. This study shows that gay men who engage in group sex represent an important priority for targeted HIV prevention activities and research.
Abstract: To determine the prevalence and risk factors for anal human papillomavirus (HPV) infection in community-based cohorts of homosexual men in Sydney, Australia.
Abstract: We explored current access to care among HIV-positive people in Australia. In 2006, 270 HIV-positive gay men from a community-based Positive Health cohort in Sydney were asked about their health (including medical and social) service needs and, subsequently, about difficulty in accessing services. We report the prevalence of specific needs, barriers and associated factors. Participants most commonly used general practitioners (64%) for HIV management and needed at least one HIV-related medical service (usually several: doctors experienced in HIV management, dentists and hospital pharmacies). Most participants were able to access them. Barriers in accessing services were related to their convenience rather than lack or quality. Cost emerged as a substantial barrier to dental care and psychological counselling (91% and 48% respectively of those in need). Need for an HIV-related social service was reported by 46% of respondents. Difficulties in accessing these related to poor services and staff attitudes. Income was associated with limited access to multiple services. In Australia, HIV-related medical service needs outweigh those for social services. Complex health services remain essential to HIV-positive people, but some services are currently not meeting their needs. To remain adequate, services need to understand and constantly adapt to the changing needs of HIV-positive people.
Abstract: Intensive sex partying is a framework developed to analyse specific frequent behaviours amongst a small minority of gay men in Sydney, Australia. The behaviours included a higher frequency of dance party attendance, more frequent sex, more anal sex, multiple sex partners, more unprotected anal intercourse with casual partners and more frequent drug taking. These occur at a contextual intersection between a sub-group of sexually adventurous gay men and 'party boys'. The men appear to be involved in both high-risk, adventurous sex practices and a specific form of partying distinguishable from dance partying and 'clubbing'. Sex partying occurs on multiple sites (domestic spaces; within dance parties; sex parties; sex-on-premises venues) and appears to be geared to the maximisation of sexual pleasure. Intensive sex partying describes this coincidence of factors and locates them in relation to the multiple pleasures offered by sex partying. It emphasises the importance of 'intensity' in order to understand better the relations between sex, drug use, pleasure, care and risk in some gay men's lives.
Abstract: Group sex has consistently been identified as one of a group of risk behaviours among gay men associated with HIV seroconversion. This paper presents a detailed description of how gender, and specifically masculinity, operates as an aspect of the discourse of gay men's group sex. The findings presented in this paper are one part of a multi-aspected discourse analysis through which we are aiming to develop an account of the discourse of gay men's group sex as it was produced in a series of qualitative interviews conducted with gay men who participate in group sex. The interviews were conducted as part of the Three or More Study (TOMS), a larger project that involved a substantial quantitative component. The overarching intent of the discourse analysis is to provide as comprehensive a mapping as possible of this discursive terrain to facilitate the targeted development of HIV and sexual health educational initiatives. The discourse of gay men's group sex reproduces some key formations of masculinity within discourses of gender, which present specific challenges for HIV prevention education. These challenges are outlined at the conclusion of this paper.
Abstract: Group sex among gay men has been associated with other HIV risk behaviours. Gay men who engage in group sex may be at increased risk of infection with HIV and other sexually transmitted infections (STI).
Abstract: Circumcision status was examined as an independent risk factor for sexually transmissible infections (STIs) in the Health in Men cohort of homosexual men in Sydney.
Abstract: Concern internationally that young gay men are at increased risk of HIV infection has not been reflected in earlier findings in Australia where younger men have not been found to be at increased likelihood to engage in unprotected anal intercourse with casual partners (UAIC). There has, however, been little attention paid to the issue of age in relation to HIV risk behaviour in Australia in recent years. In 2007, among men who completed Gay Community Periodic Survey questionnaires in Sydney, Melbourne and Brisbane, Australia, younger men were more likely to report being in relatively short-term monogamous relationships than were their older counterparts. They were also less likely to know their own or their partners' HIV serostatus. Men aged less than 25 years reported fewer recent partners and were less likely to report sex with casual male partners in the previous six months (p<0.001). Younger men were also less likely to engage in group sex. Approximately, one-quarter of the sample reported engaging in any UAIC in the previous six months during each year of the survey. Younger men were no less likely to report UAIC overall, but they were somewhat more likely to report taking the receptive position during UAIC. While age is a consideration in the assessment of risk of HIV transmission among gay men, this risk is dependent upon the context in which it occurs: Age mixing may be an important consideration in understanding HIV risk among young gay men.
Abstract: Using two cohort studies (Health in men-HIM and positive health-PH) and repeated large cross-sectional surveys (Gay Community Periodic Survey-GCPS) of gay men in Sydney, Australia, we examined the association between viral load and unprotected anal intercourse (UAI) between HIV sero-discordant regular partners. Between 2001 and 2007, we conducted 243 interviews with 102 HIV-negative gay men in HIM and 148 interviews with 99 HIV-positive gay men in PH who were in regular relationships with HIV sero-discordant partners. During the same time period, 437 HIV positive men with HIV sero-discordant regular partners completed questionnaires for the GCPS. All completed interviews or questionnaires during that time period were used for these analyses. Amongst the HIV-negative respondents, sero-discordant UAI was more likely to be reported when the men believed their HIV-positive regular partner had an undetectable rather than a detectable viral load (P = 0.002). Amongst the HIV-positive respondents, sero-discordant UAI was as likely to be reported when they themselves reported having an undetectable or a detectable viral load. Use of viral load in negotiating condom use between sero-discordant gay couples may be understood very differently by the HIV-negative and HIV-positive men within those partnerships.
Abstract: We explored seroguessing (serosorting based on the assumption of HIV seroconcordance) and casual unprotected anal intercourse (UAIC) associated with seroguessing. The ongoing Positive Health and Health in Men cohorts, Australia, provided data for trends in seroconcordant UAIC and HIV disclosure to sex partners. In event-level analyses, we used log-binomial regression adjusted for within-individual correlation and estimated prevalence rate ratios (PRRs) and 95% confidence intervals (95% CIs) for the association between the knowledge of a casual partner's seroconcordance and UAIC. UAIC and HIV disclosure significantly increased during 2001-2006. HIV-positive men knew partners were seroconcordant in 54% and assumed it in 13% of sex encounters (42 and 17% among HIV-negative men). Among HIV-positive men, the likelihood of UAIC was higher when a partner's status was known (Adjusted PRR = 5.17, 95% CI: 3.82-7.01) and assumed seroconcordant because of seroguessing (Adjusted PRR = 3.70, 95% CI: 2.56-5.35) compared with unknown. Among HIV-negative men, the likelihood of UAIC was also higher when a partner's status was known (Adjusted PRR = 1.88, 95% CI: 1.58-2.24) and assumed seroconcordant (Adjusted PRR = 2.12, 95% CI: 1.72-2.62) compared with unknown. As levels of UAIC remain high, seroguessing increasingly exposes gay men to the risk of HIV infection. Because both HIV-positive and HIV-negative men often seroguess, education and prevention programs should address the fact that HIV-negative men who engage in UAI due to this practice may be at high risk of HIV infection. HIV prevention should take into account these contemporary changes in behaviors, especially among HIV-negative gay men.
Abstract: Drug use has been associated with risk behaviour among gay men. We examined the use of drugs and sexual risk behaviour among homosexually-active men who engaged in group sex in Australia.
Abstract: 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.
Abstract: To investigate the relationship between nonoccupational postexposure prophylaxis (NPEP) use and future HIV risk behaviours and HIV infection in a cohort of HIV-negative homosexual men in Sydney, Australia.
Abstract: The relevance of circumcision in preventing male-to-male sexual transmission of HIV is poorly understood, in particular because any potential beneficial effect could be diminished by the impact of circumcision on sexual behavior.
Abstract: In Australia, the HIV epidemic is concentrated among gay men. In recent years, the number of new diagnoses stabilised in New South Wales (NSW), but increased in other states. We reviewed the trends in sexual behaviours to explain this difference.
Abstract: To determine if there were any differences in antiretroviral treatment (ART) use across the three eastern states of Australia, New South Wales (NSW), Victoria and Queensland, during the period 1997 to 2006.
Abstract: To determine the prevalence, incidence and risk factors for pharyngeal Chlamydia trachomatis in the community based Health in Men (HIM) cohort of HIV negative homosexual men in Sydney, Australia.
Abstract: In order to be effective, sexually transmitted infection (STI) testing should be comprehensive based on the clients' sexuality and risk practices. Using data from the Sydney Gay Community Periodic Survey, we explored trends in and factors associated with STI testing among gay men during 2003-2007. Among men who were not HIV-positive, 68% were tested for HIV in 2007. HIV testing was more common than STI testing and remained stable during 2003-2007. Use of swabs and urine samples increased significantly (P-trend<0.001 for each). However, until 2007, 33% of men were not tested. Sexual behaviours (higher number of partners, having casual partners and engaging in unprotected anal intercourse with them) were associated with STI testing. HIV-negative men were tested for STI less often than HIV-positive men (prevalence ratio=0.56; 95% CI: 0.47-0.68). STI testing among HIV-negative men has improved significantly but remains inadequate for STI control and HIV prevention. It should not be assumed that appropriate and comprehensive STI screening is always provided to clients.
Abstract: Between 1998 and 2007, 51,449 Gay Community Periodic Survey questionnaires were completed in Sydney, Melbourne and Brisbane, Australia. These included 23,424 where the respondents reported currently being in a relationship with a regular male partner. About 90% of men with a regular partner had been tested for HIV, and about three quarters had tested HIV-negative. Between 1998 and 2007 there was an increase in the proportion of men in HIV-negative seroconcordant relationships. About three quarters of men with a regular partner had negotiated an agreement about sex within their relationship. There was little change over time in the likelihood of having negotiated such agreements. There were, however, changes over time in the nature of these negotiated agreements: Over time, more men in HIV-discordant relationships permitted unprotected anal intercourse with their regular partners (P-trend < .001); among men in HIV-negative concordant relationships, an increasing proportion required a monogamous arrangement with their regular partner (P-trend < .001); and over time, fewer men in general required consistent condom use with casual partners (P-trend < .001). Some of these changes in negotiated agreements represent an increase in the potential risk of HIV transmission.
Abstract: We examined whether trends in HIV testing in community-based samples of homosexual men may account for the convergence in HIV notification rates in homosexual men across the eastern states of Australia.
Abstract: Misreporting of circumcision status may affect observed relationships between circumcision status and HIV or other sexually transmissible infections. As no data exist on the validity of self-reported circumcision status among homosexual men, we investigated the agreement between self-report and examination findings in a subgroup of participants in the Health in Men (HIM) study in Sydney, Australia.
Abstract: To assess the size, distribution and changes in the population of homosexual and bisexual men in Australia, and the capacity of available measures to make this estimation.
Abstract: In Australia, HIV notification rates in homosexual men, previously much higher in New South Wales, have become similar across the eastern states. We examined whether trends in HIV prevalence in community-based samples of homosexual men were consistent with the trends in HIV notifications.
Abstract: The objective of this study was to determine the prevalence, incidence, and risk factors for genital and anal warts in HIV-negative homosexual men in Sydney.
Abstract: By measuring the actual number of risk acts engaged in by HIV-positive men participating in the Positive Health (PH) cohort study, this paper sets out to document the distribution of risk acts, to report on the proportion of acts of unprotected anal intercourse with casual (UAIC) partners that occurred between HIV-positive men (i.e. seroconcordant positive) and to examine the factors that differentiated men who 'frequently' compared with 'sometimes' or 'never' engaged in unsafe UAIC (i.e. UAIC with serononconcordant partners: partners who have not tested positive for HIV). The findings show that 42.6% of all UAIC acts occurred between seroconcordant HIV-positive partners, posing no risk of HIV infection to an HIV-negative person. A minority of participants (10%) accounted for the majority (70.7%) of the unsafe acts of UAIC. The HIV-positive men who 'sometimes' engaged in unsafe UAIC had higher treatment optimism scores and were more likely to use Viagra in comparison with those who did not engage in such risk. Those who reported 'frequent' engagement in unsafe UAIC were more likely to engage in a range of esoteric sexual practices, be slightly less well educated and be taking antiretroviral therapy compared with HIV-positive men who 'sometimes' engaged in unsafe UAIC. As such, taking ART but not viral load, predicted frequent unsafe UAIC. When considered alongside earlier studies, these results suggest that HIV-negative men who engage in esoteric sexual practices may be at increased risk of HIV transmission, not necessarily because they engage in esoteric sex practices but because of the sub-cultural milieu in which esoteric sex is occurring. The findings from this study also endorse the measurement of UAIC acts as a useful gauge of risk.
Abstract: Therapeutic use of marijuana has emerged as an important issue for people living with cancer, HIV/AIDS and multiple sclerosis. This paper examines therapeutic use of marijuana in the Positive Health cohort study, a longitudinal cohort study of men and women living with HIV/AIDS in NSW and Victoria, Australia. Factors that distinguish therapeutic use of marijuana from recreational use were assessed by comparisons on a range of social and health-related variables. The results show that among 408 participants, 59.8% reported some use of marijuana in the past six months. Of those participants (n=244), 55.7% reported recreational use only of marijuana and 44.3% report mixed use of marijuana for therapeutic and recreational purposes. Multivariate logistic regression analysis showed that participants who used marijuana for therapeutic purposes were significantly more likely than recreational-only users to have used other complementary or alternative therapies, experienced HIV/AIDS-related illness or other illnesses in the past 12 months, had higher CD4/T-cell counts, had lower incomes, be younger in age and less likely to have had a casual partner in the six months prior to interview. These results show that a substantial proportion of people living with HIV/AIDS (PLWHA) use marijuana for therapeutic purposes, despite considerable legal barriers, suggesting marijuana represents another option in their health management. Rather than solely using marijuana in response to illness, the experience of illness may influence a person's understanding of their marijuana use, so that they come to understand it as therapeutic. Further research might consider possible interactions between cannabinoids and antiretroviral treatments, potential use of oral THC and the difficulties faced by clinicians and PLWHA in discussing marijuana in the current legal context.
Abstract: Rates of use of amphetamine type stimulants among gay men have raised questions about the role of these drugs in increases in HIV infections and risk behaviour, but the role risk behaviours play with regard to illicit drug use within this population has not been investigated.
Abstract: 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'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.
Abstract: Gay men who engage in sex work may be at increased risk through risk behaviour outside the context of sex work. Among participants in the Health in Men (HIM) cohort of HIV-seronegative gay men in Sydney, 19.7% had ever engaged in sex work. Five percent reported being paid for sex in a six-month period during the study (2001-2006); a minority (18.3%) of these current sex workers reported unprotected anal intercourse (UAI) with clients and 62.0% reported UAI with any casual partners. The practice of sex work itself may not represent increased risk for HIV transmission but sex workers in this study were, nonetheless, at markedly increased risk in other aspects of their lives.
Abstract: 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.
Abstract: Male circumcision may reduce the risk of HIV acquisition in heterosexual men. In observational studies, confounding by demographic factors could produce spurious associations between circumcision and HIV risk. To assess this possibility, cross-sectional data on self-reported circumcision status and demographic factors were collected at baseline as part of the Health in Men study. Two-thirds of 1426 subjects were circumcised, mostly in the neonatal period. In multivariate analyses, age, ethnicity and country of birth were independently associated with circumcision status. Confounding by these demographic factors must be considered in future epidemiological studies addressing circumcision and HIV acquisition.
Abstract: To determine any differences in HIV-risk and drug-use behaviour among Aboriginal and Torres Strait Islander gay men and other gay men in Australia.
Abstract: This paper addresses the question of whether HIV-negative gay men engage in "serosorting" in casual encounters. Serosorting, defined as engaging in unprotected anal intercourse with casual partners who they report to be HIV negative, has been increasing among HIV-negative gay men in Sydney. Prevention and intervention programmes are urgently needed to alert HIV-negative gay men to the risks associated with "serosorting", and remind them of the need for consistent condom use.
Abstract: In recent years, increases in both risk behavior and in seroconversion among homosexually active men have been noted in a number of parts of the world. Data were available from 903 HIV negative homosexual men regarding number of acts of unprotected anal intercourse (UAI), separated into receptive and insertive UAI, with and without ejaculation, with steady and with casual partners. Partners were classified according to serostatus as reported by respondents. Men (N = 325) reported 13,692 UAI acts, most of which were with steady partners, of whom most were reported to be HIV-negative. With HIV-positive partners, both steady and casual, and with casual partners of unknown serostatus, receptive UAI with ejaculation was relatively rare. Insertive UAI without ejaculation was relatively common with casual partners of unknown serostatus. Patterns of UAI suggest that risk of transmission may be greater with steady partners. Men appear to modify practice according to both the nature of the relationship (steady or casual) and (assumed) serostatus of partner.
Abstract: This paper reports on the breaking of agreements between regular partners among HIV-negative gay men in Sydney. Data were from the 1333 men completing face-to-face interviews through December 2003 for the Health in Men (HIM) open cohort of HIV-negative gay men in Sydney.822 men had a primary regular partner during the six month period before their 2003 interview. Most of these men had entered into agreements with their partners about sex either with each other or with other partners (87.2%). They most commonly agreed not to use condoms with each other (50.6%). Regarding casual sex, they most commonly agreed to always use condoms (34.2%) or to have no sex with men outside their relationships (28.6%). 48.8% reported some discomfort discussing with their partner their sex outside the relationship. Among those with agreements with their partners, 27.7% reported ever breaking those agreements. Those who found it more difficult to discuss issues of HIV serostatus and sexuality were more likely to report having broken their agreements (p<.001; p=.021 at one-year follow-up) and were more likely to have engaged in unprotected anal intercourse with casual partners (p<.001). A third of those men who broke their agreements did not inform their partner. A substantial proportion of gay men with agreements with their regular partners report some discomfort discussing sexuality and HIV serostatus with their partners. Difficulty discussing these issues may place these men at increased risk of breaking their agreements and may place both themselves and their partners at increased risk of infection.
Abstract: Past research on unprotected anal intercourse with casual partners (UAIC) contrasts those who report no UAIC with any UAIC. This paper examines differences among three groups of men who had any UAIC on the basis of the number of UAIC acts reported in a six-month period, namely no UAIC (n = 507), occasional UAIC (1-5 acts, n = 251) and frequent UAIC (more than 5 acts, n = 148). The occasional UAIC group had values lying between those of the no- and the frequent-UAIC group. As compared with the frequent-UAIC group, men in the occasional-UAIC group were less likely to have a steady partner, held less favorable attitudes toward condoms and higher levels of HIV treatments optimism and were more likely to report some disclosure of serostatus to or by casual partners and a range of esoteric sexual practice. On the other hand, men in the no-UAIC group had lower levels of 'feeling bad' (distress) and were less likely to use drugs to enhance sexual pleasure in casual encounters. Disclosure of serostatus had a strong association with frequent UAIC and this finding calls for both more research and more community exploration of issues surrounding sexual decision-making.
Abstract: To determine whether reporting that the HIV-positive partner's viral load is undetectable rather than detectable is associated with unprotected anal intercourse (UAI) in HIV serodiscordant gay couples.
Abstract: To describe trends in the notification of infectious syphilis in New South Wales, the characteristics of homosexually active men recently notified with early syphilis, and the seroprevalence and incidence of syphilis, as well as associated risk factors, in a Sydney cohort of HIV-negative homosexually active men.
Abstract: Communities most affected by HIV/AIDS have been instrumental in shaping Australia's responses to the threat of the epidemic. There are recent signs that levels of engagement in communities based around HIV-positivity have changed: a diminished sense of an AIDS crisis, the relative success of highly active antiretroviral therapy (HAART), and an increasing individualization of the HIV experience may be contributing to changes in the way HIV-community is experienced. In this paper, we explore levels of engagement in HIV-positive community among a cohort of people living with HIV/AIDS (PLWHA) and seek to explain why some PLWHA engage in an HIV-positive community while others do not. Using multivariate logistic regression, we found that three factors were independently related to feeling part of an HIV-positive community: having been diagnosed with HIV prior to the advent of HAART; having more recently taken Bactrim or Septrin for PCP; and finding it easier to take 'pills' on time. Taken together, these results suggest that both historical effects, such as the introduction of HAART, and effects related to living with HIV, such as the experience of an AIDS-related illness, help explain HIV-positive community engagement among PLWHA.
Abstract: Human herpesvirus 8 (HHV-8) is a common sexually transmitted agent among homosexual men, but there are few Australian data. We aimed to describe the prevalence and risk factors for seropositivity to HHV-8 in Australian homosexual men.
Abstract: The objective of the paper was to compare encounters involving unprotected anal intercourse (UAI) and protected anal intercourse (PAI) among HIV-negative gay men in Sydney. Data were from those completing baseline face-to-face interviews to end June 2003 for the Health in Men open cohort of HIV-negative gay men in Sydney. The 1,148 participants ranged in age from 18 to 75 years (median = 36). Three hundred and fifty-two (30.7%) reported an occasion of UAI with a casual partner in the previous 6 months and 531 (46.3%) reported an occasion of UAI with a regular partner in that same time. The men's most recent sexual contact with a casual partner involving UAI was distinguished from those involving PAI by a greater likelihood for both partners to disclose HIV serostatus (p = 0.006) and by respondents being more inclined to restrict themselves to the insertive position or to practise withdrawal during occasions involving any UAI than when a condom was used (p = 0.003 and p = 0.001 respectively). Neither location nor recreational drug use differentiated men's most recent sexual contacts involving UAI from those involving PAI. The decision by HIV-negative gay men to use condoms during sexual encounters with either regular or casual partners is guided more by HIV serostatus and risk reduction strategies than by other factors.
Abstract: This study aimed to determine and describe HIV-negative gay men's willingness to participate in HIV vaccine trials. Data were from participants who completed face-to-face interviews during the first 18 months (to the end of 2002) of recruitment into the Health in Men cohort of HIV-negative gay men in Sydney. A key outcome measure was a scale of Willingness to Participate in HIV Vaccine Trials, with scores ranging from 1 (unwilling) to 4 (willing). The 903 participants ranged in age from 18 to 75 years (median = 36). Mean of Willingness to Participate in HIV Vaccine Trials was 2.53 (standard deviation = 0.54), with approximately 51% of the men having a score greater than the midpoint of 2.50. A reduced linear regression model yielded four significant independent associations with Willingness to Participate in HIV Vaccine Trials: lack of tertiary education (P < 0.001),having engaged 'in the previous six months' in any unprotected anal intercourse with casual or non-concordant regular partners (P < 0.001), higher self-rated likelihood of HIV infection (P < 0.01), and higher mean scores on a scale of Comfort with Participation in HIV Vaccine Trials (P < 0.001). The willingness of HIV-negative gay men at potentially higher risk for HIV to participate in HIV vaccine trials augurs well for enrolment in HIV vaccine efficacy trials. Recruitment into trials is likely to be enhanced by addressing salient concerns such as confidentiality and vaccine-induced antibody positivity. Also, it will be important to ensure that gay men are educated and fully informed about HIV vaccines and trial processes.
Abstract: To determine the prevalence and incidence of hepatitis A (HAV) and B (HBV) infection and vaccination in HIV-negative homosexual men in Sydney, and associated risk factors.
Abstract: Previous mathematical models have indicated that any decrease in HIV incidence in homosexual men due to decreased infectiousness from antiretroviral treatment (ARV) may be offset by modest increases in unsafe sex. The aims of this study were to assess the effects of ARV use and increasing unprotected anal intercourse with casual partners (UAIC) in homosexual men on HIV incidence during 1995-2001 and to project HIV incidence depending on trends in ARV use and UAIC.
Abstract: After massive and sustained reductions in HIV risk behaviour amongst Australian gay men in the 1980's and early 1990's, since 1996 there have been signs of small but significant increases in unprotected analintercourse. Gay communities are responding to a post crisis context. However, is this response constant across different locations? This paper investigates changes in sexual negotiation and behaviour amongst gay men in the relatively small Australian city of Perth between 1998 and 2002 and compares these results to similar studies in Sydney, an Australian HIV epicentre city. A number of important similarities and differences between the Perth and Sydney samples are identified, particularly in casual contexts and disclosure of HIV status, identifying that isolated or smaller cities may experience similar phenomena to larger cities, but these may be due to different reasons. The findings point to the need for complementary qualitative research and cautions health promotion practitioners to test their assumptions when developing responses to prevent HIV transmission.
Abstract: Against a background of increasing unprotected anal intercourse (UAI) in the Sydney gay community (and internationally), complementary cross-sectional surveys of sexual practice were conducted among gay men of Asian background in 1999 (N = 319) and 2002 (N = 457). Self-complete questionnaires were used with recruitment at gay bars, gay social functions, and gay sex-on-premises venues. In 2002, self-report HIV status was 73.7% HIV-negative, 3.6% HIV-positive, and 22.8% unknown status (no significant change from 1999). Over time, the proportion of gay Asian men who reported any UAI with regular partners (in the previous 6 months) did not change significantly: 27.9% in 1999; 24.3% in 2002. Similarly, rates of any UAI with casual partners remained steady: 16.3% in 1999; 14.4% in 2002. Only one factor, more extensive engagement in esoteric practices (fisting, sadomasochism, group sex, rimming), was independently associated with sexual risk practice. This suggests that risk in this population of gay men, as in others, has more to do with the sexual cultures in which men are embedded rather than individual-level differences.
Abstract: To describe time trends and other predictors of recent HIV testing among homosexual men enrolled in behavioural surveillance studies in Australia.
Abstract: The aim of this analysis was to examine gay men's sexual risk practice to determine patterns of risk management. Ten cross-sectional surveys of gay men were conducted six-monthly from February 1996 to August 2000 at Sydney gay community social, sex-on-premises and sexual health sites (average n = 827). Every February during this period, five identical surveys were conducted at the annual Gay and Lesbian Mardi Gras Fair Day (average n = 1178). Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with a serodiscordant regular partner, there was a clear pattern of sexual positioning. Few regular couples were both receptive and insertive. Most HIV-positive men were receptive and most HIV-negative men were insertive. Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with casual partners, there was also a pattern of sexual positioning. Whereas many casual couples were both receptive and insertive (especially those involving HIV-positive respondents), among the remainder HIV-positive men tended to be receptive and HIV-negative men tended to be insertive. These patterns of HIV-positive/receptive and HIV-negative/insertive suggest strategic risk reduction positionings rather than mere sexual preferences among a minority of gay men. If so, they point not to complacency but to an ever more complex domain of HIV prevention.
Abstract: This study aimed to develop reliable scales of HIV vaccine attitudes. Gay men were recruited at the 2001 Sydney Gay and Lesbian Mardi Gras Fair Day, a large gay community gathering of thousands of people. A total of 776 participants completed a questionnaire containing 38 items about HIV vaccines. Factor analysis of the responses of 585 HIV-negative/untested men revealed four distinct factors (accounting cumulatively for 24.5% of the variance): I, Comfort with Participation in HIV Vaccine Trials, Cronbach alpha = 0.81; II, Confidence in HIV Vaccines/Vaccine Trials, Cronbach alpha = 0.71; III, Sexual Freedom, Cronbach alpha = 0.64; IV, Willingness to Participate in HIV Vaccine Trials, Cronbach alpha = 0.59. Of the HIV-negative/untested men, 162 (27.7%) were likely/very likely to volunteer for HIV vaccine trials, and 422 (72.3%) were unlikely/very unlikely to do so. As preliminary evidence of construct validity, the 162 men had a higher mean score on scale I (2.79), indicating greater comfort with trial participation than their 422 counterparts (2.47, p < 0.001). As preliminary evidence of concurrent validity, the 162 men had a higher mean score on scale IV (2.79), indicating greater willingness to participate than the rest (2.22, p < 0.001). Alongside HIV vaccine trials, these scales may be a useful adjunct to social research in gay communities; to monitor and be responsive to community concerns about HIV vaccine trials as well as their potential to undermine safe sex practices.
Abstract: Total rates are low, but sex with a man remains the main risk for HIV transmission to women in Australia. In February 1998, 774 women in contact with gay, bisexual and lesbian communities completed a two-page questionnaire. Almost all respondents had some social contact with gay men. Two-thirds (503) thought of themselves as lesbian/dyke/homosexual/gay, 13% (100) as bisexual and 17% (133) as heterosexual/straight. In total, 212 women (27%) said they had ever had sex with a gay or bisexual man; 51 women (7%) had done so in the past six months. About 2% of the lesbians said they had recently had sex with a gay/bi man, as had 8% of the heterosexuals and 25% of the bisexuals; 25 women had recently had unprotected vaginal or anal intercourse with a male gay/bi partner. Forty-eight women (6%) had done sex work. Asked about drug use, 61 women (8%) said they had injected in the past six months. Twenty-three women had shared injecting equipment with someone, and five had shared with a gay/bi man. Compared with other women, these women have high rates of injecting drug use. If they have sex with men, these men are more likely to be gay or bisexual than are the male sexual partners of women moving in largely heterosexual milieux. For a case of so-called 'heterosexual' transmission of HIV to occur, neither person need be heterosexual.
Abstract: Some gay men disclose their HIV serostatus to enable them to decide to discard condoms in at least some casual encounters. In this paper we consider under what circumstances this occurs. We draw on data from the Sydney Men and Sexual Health cohort study, including both structured and semi-structured interviews. We find that casual sexual encounters among gay men are complex events, involving a broad range of types of partner and circumstance. A significant minority of men disclose their HIV serostatus; 36.3% of those who discussed their serostatus with casual partners engaged in unprotected anal intercourse (UAI) with those partners, while only 9.9% of those who did not discuss their serostatus engaged in UAI with those partners. We also find that disclosure of HIV serostatus, discussion and use of condoms during casual encounters are affected by the particular circumstances of those encounters, including the degree of familiarity between casual partners.
Abstract: It is important to know if optimism about HIV treatments is widespread and whether it is growing. To this end, cross-sectional surveys of gay men were conducted 6-monthly in Sydney between February 1997 and February 1999 (n = 3012). Recruitment was consistent at 4 gay community venues. The participants responded True, False or Unsure to 5 statements about the effectiveness of HIV treatments (2 items), and transmission (2 items) and 'worry' (1 item) in the context of treatments. In terms of effectiveness, HIV-positive men were more likely than non-positive men to dismiss 'cure' (P < 0.05) and more likely to support 'treatments prevent serious illness' (P < 0.001). Uncertainty about effectiveness decreased over time (P < 0.001 for each item). In terms of transmission, HIV-positive men were more likely than non-positive men to reject notions of reduced infectivity (P < 0.001). Over time, there was less uncertainty among non-positive men about undetectable viral load and transmission possibilities (P < 0.001). Overall, HIV-positive men were less 'worried' than non-positive men (P < 0.001) but there were no changes over time. On the whole, gay men in Sydney are now less uncertain about highly active antiretroviral therapies (HAART) than at the time of their introduction. Most men remain sceptical that these treatments can cure HIV infection and prevent HIV transmission, but in regard to managing illness among those infected, some initial uncertainty is being replaced by a growing optimism about the efficacy of treatments.
Abstract: To assess the competing effects on HIV incidence in homosexual men of the decreased infectiousness of men with HIV receiving effective combination antiretroviral treatments and homosexual men engaging in unprotected anal intercourse with increased numbers of partners (levels of unsafe sex).
Abstract: The aim of this research was to develop a brief scale of gay men's optimism-scepticism in the context of new HIV treatments. Following comprehensive literature search and communication with other researchers, 34 items about viral load testing, HIV therapies and concern about HIV infection were generated. By way of anonymous, self-complete questionnaires, these items were put to 532 gay men recruited at the Sydney Gay and Lesbian Mardi Gras Fair Day in February 1999. Principal axes factor analysis and item refinement yielded an optimism-scepticism scale based on 12 items (range 12-48, with higher scores indicating greater optimism). The sample mean was 19.8 (SD = 4.7). The scale had high internal consistency reliability (Cronbach's alpha = 0.79). Providing preliminary evidence of validity, men who reported unprotected anal intercourse with a causal partner 'in the past six months' had a significantly higher mean score (21.3) than those who did not report this risk practice (19.5, p < 0.001). Similar validation was provided from separate samples of gay men in Queensland and Sydney. Our scale of optimism-scepticism in the context of new HIV therapies is a brief, reliable instrument which can be incorporated within broader questionnaires and interview schedules. It is a useful tool to monitor attitudes toward HIV therapies and possible associations with risk practices.
Abstract: Whereas most gay men in Australia know their HIV test result, a consistent minority do not. From Gay Community Periodic Surveys (n=6831) conducted during 1998 in the 5 largest cities, those who did not have HIV test results (13.3% overall) comprised 10.0% in Sydney, 15.7% in Melbourne, 13.6% in Brisbane, 15.2% in Perth and 14.0% in Adelaide, representing a significant difference between cities (P < 0.001). Gay men who did not have HIV test results differed from those who did in several ways. They were on average younger (31 vs 35 years, P<0.001) and less likely to be in professional occupations (P<0.001). They were less likely to identify themselves as 'gay' (P<0.001), spent less time with other gay men (P<0.001) and had fewer gay friends (P<0.001). They had sex with fewer different men 'in the previous 6 months' (P<0.001) and were more likely to be in a monogamous relationship or without sexual partners at the time of the survey (P<0.001). With respect to both regular and casual partners, they were more likely (P<0.001) to have 'no such partner'/'no anal intercourse' rather than 'anal intercourse' (either always protected or sometimes unprotected). These differences between gay men who did and did not have HIV test results were confirmed in a logistic regression (apart from 'amount of free time spent with gay men' and 'relationship status' which were accounted for by closely correlated variables in the reduced logistic model). Social and sexual environment appears to exert an influence on HIV testing rather than sexual risk per se.
Abstract: A case control analysis within an ongoing cohort study was used to examine differences between seroconverters and men who remained HIV-negative. The cases were interviewed within one to 13 months prior to their seroconversion. Their responses to a structured questionnaire were compared with those of HIV-negative controls drawn from the same time period and from the same longitudinal study, Sydney Men and Sexual Health. Data collected from both cases and controls included: demographic and contextual variables, knowledge of HIV transmission, sexual practices, drug and alcohol use and attitudinal factors. The aim was to compare the sexual behaviours, and the social and cultural contexts of such behaviours, of men prior to their HIV seroconversion with men who did not seroconvert. Twenty-three men had seroconverted within the cohort. Cases were identified by a positive HIV antibody test or self-report of positive HIV status following a previous negative HIV test. Three-hundred-and-sixty-nine controls were selected on the basis of being HIV negative at interview in 1994, and having at least one subsequent medically-confirmed negative HIV antibody test. Univariate predictors of seroconversion were: being in a regular relationship with a known HIV-positive partner, drug use, and engaging in a range of anal and esoteric sexual practices. Practices commonly used to enhance sexual pleasure, such as group sex, watching and being watched having sex, the use of sex toys and dressing up/fantasy, were engaged in more frequently by seroconverters. Engaging in these esoteric sexual practices was highly correlated with drug use, involvement in the gay community and engagement in a wide range of anal practices. In the multivariate analysis independent predictors of seroconversion were: younger age; being in a regular relationship with a known HIV-positive partner; believing withdrawal to be safe with regard to HIV transmission; and range of esoteric practices. These results indicate the importance of the social and cultural contexts of particular sexual practices and consequent HIV transmission. Sexually adventurous men may be at increased risk for HIV because they seek sex within particular sexual sub-cultures.
Abstract: We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly with a view to investigating any behavioural changes after the recent improvements in antiretroviral therapies. Trends in unprotected anal intercourse were monitored through the Sydney Gay Community Periodic (cross-sectional) Surveys which were conducted at six-monthly intervals between February 1996 and February 1998. Gay men (n = 2,863) were recruited and self-completed a short questionnaire at three gay venues and a sexual health clinic. There was a significant increase in unprotected anal intercourse with casual partners (but not with regular partners), applicable to both HIV positive and HIV negative men. Sexual practice was generally unrelated to ideas about recent advances in viral load testing and combination therapies.
Abstract: We set out to determine the frequency and correlates of gay men's repeated unprotected anal intercourse with casual partners (UAI-C), defined as UAI-C reported at each of 3 annual interviews. By May 1997, 659 men had completed 3 annual interviews for the Sydney Men and Sexual Health (SMASH) cohort study. For the 3 6-month periods prior to each interview, 127 men reported UAI-C during one period only; 45 reported it during 2 periods; and 20 men reported it during all 3 periods. These 20 men who had repeated UAI-C were compared with 497 men who had anal intercourse with casual partners but did not report on all 3 occasions that they had UAI-C. Logistic regression revealed that repeated UAI-C was associated with HIV-positive status, more casual partners, less favourable attitudes toward condoms and greater recreational drug use. Few gay men have repeated UAI-C but those who do run greater risk of HIV transmission.
Abstract: Many commentators have positioned Western gay youth as a high-risk group for HIV infection and obscured important cultural, social, and contextual differences between populations. This study compares risk of HIV transmission factors among 216 young (under 25 years) and 822 older (25 years or over) homosexually active men, recruited through Sydney gay community and other sources. Bivariate and multivariate analyses of survey data that were collected by personal interviews consistently supported our hypothesis of no difference in HIV-related risk factors between young and older men. Although young men in this cohort were more likely to be of unknown serostatus, they were at least as knowledgeable, as attached to gay community, and as precautionary in their sexual behaviors with regular and casual male partners as their older counterparts. Safety campaigns targeting these young gay men should focus, for example, on their lower rates of HIV antibody testing and not be based on a false premise of hedonistic, uninformed, and disenfranchised youth.
Abstract: The aim of this study was to provide current data on the sexual practices in a broad cross-sectional sample of gay and homosexually active men in Sydney. Anonymous, short questionnaires were completed by 1611 gay men recruited at the 1996 Gay and Lesbian Mardi Gras Fair Day or at one of six venues (including two sexual health centres) across the metropolitan area during the following week. The sample was diverse, but the men tended to be of Anglo-Australian background, well educated, professionally employed, attached to gay community and gay identified. They mainly had sex with other men rather than with men and women. Most (86.0 per cent) had been tested for human immunodeficiency virus. Excluding 241 men recruited in sexual health centres, 11.2 per cent were HIV-positive and 73.4 per cent were negative. Where it occurred in regular relationships, unprotected anal intercourse was usually between seroconcordant partners (78.5 per cent). Unprotected anal intercourse between discordant or nonconcordant regular partners was much less common, and in about half the cases involved withdrawal prior to ejaculation exclusively rather than ejaculation inside. Almost 12 per cent of the men had at least 'occasionally' engaged in unprotected anal intercourse with a casual partner in the previous six months, with approximately half of these men having adopted a withdrawal strategy on every occasion. We conclude that short surveys can provide valuable and timely data on sexual practices in a broad cross-sectional sample of gay and homosexually active men. Key messages for those involved in gay men's education are the high rates of unprotected anal intercourse between casual partners and the extensive practice of withdrawal.
Abstract: To test the safety of the 'negotiated safety' strategy-the strategy of dispensing with condoms within HIV-seronegative concordant regular sexual relationships under certain conditions.
Abstract: Between July 1993 and March 1994, advertising in the personal columns of local print media was used as a subterfuge to obtain access to homosexually active men living on the Central Coast of New South Wales. The men were invited to make contact by phone and were then requested to answer 44 survey questions. The survey was based on a premise that there existed a subgroup of homosexually active men who did not identify themselves as gay and who were behaviourally bisexual (the study population). Out of 296 contacts, 106 completed questionnaires concerning demographics, aspects of sexual behaviour, and attitudes and knowledge about sexual practice and self-definition. The sampling did provide access to a predominantly behaviourally bisexual group of men who did not identify themselves as gay and for whom the use of 'beats' was the most common method for meeting other men. There existed a high degree of accurate knowledge and practice of safe sex. However, several areas of concern warrant continued and new strategies to minimise the risk of human immunodeficiency virus (HIV) transmission in the study population. While the results might not be generalisable to the entire population of behaviourally bisexual men who do not identify themselves as gay, they do (in the absence of other successful ways of reaching this group), provide a useful indicator for the development of such strategies.
Abstract: One hundred and seventy-six men who had engaged in sexual activity with other men in the past six months were interviewed, in the western area of Sydney, about their sexual activities and knowledge as related to the acquired immunodeficiency syndrome (AIDS). Comparisons were made between men who had frequented "beats" (public toilets, parks or isolated roads where men meet for homosexual encounters) in the past six months, and those who did not use beats. One-quarter of those men who frequented beats reported beats as their only venue for meeting men for sexual contact, while other men reported them as one of many venues that they used to meet men. Although all interviewed men were engaging in sexual activities with men, 12 men described themselves as heterosexual, and 12% of those men who used beats, and 7% of the beat non-users, were married or in de-facto relationships. In comparing those who used beats with the beat non-users, 64% of beat users had engaged in sexual practices with between six and 50 different partners in the past six months compared with 8% of beat non-users. Beat users also were more likely to engage in unprotected anal intercourse with causal partners. Nineteen men claimed to be HIV-seropositive for the human immunodeficiency virus, with 11 of these men still engaging in high-risk sexual activities. The implications for AIDS education are discussed.
Abstract: Fifty-four actively bisexual men with recent sexual experiences with both men and women were interviewed as part of a wider study of 176 homosexual men, many of whom frequented "beats" (public toilets, parks and isolated roads where men meet for homosexual encounters). Forty-six per cent of the bisexual men were engaging in unsafe sexual practices with at least one man and one woman. Three of these men knew that they were seropositive for the human immunodeficiency virus, with two of these men engaging in unsafe sexual practices with some of their partners. Fewer than one-quarter of the bisexual men identified with or participated actively in aspects of organized, overt "gay" culture. So-called "closeted" bisexual men are suggested to be a major, but neglected, target for educational efforts against the acquired immunodeficiency syndrome.
