HIV optimism does not explain increases in high-risk sexual behaviour among gay men of positive or negative HIV status in Sydney, Australia.
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Adolescent↗
Biomedical subjects
Susan Kippax
Publications and source records attributed to Susan Kippax.
Risk factors for HIV seroconversion in homosexual men in Australia.
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 six months including the HRE. Men were more likely to report receptive UAI at their HRE when they perceived a partner to be HIV-negative as compared with when they perceived a partner to be HIV-positive (P = 0.05). Injection drug use was reported by 22% of the men in the previous six months, and 62% reported intoxication with alcohol (> or =5 drinks) or mood altering recreational drug use at the HRE. CONCLUSIONS: Gay and bisexual men who have recently seroconverted are highly sexually active and report high rates of unprotected anal intercourse and recreational drug use at the HRE.
Australia↗
Demographic predictors of circumcision status in a community-based sample of homosexual men in Sydney, Australia.
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.
Adult↗
A public health dilemma: a testing question.
The current moves to provide access to antiretroviral therapy (ART) to all in need has led to a push to HIV test. In particular, there have been policy moves endorsed by the World Heath Organization and UNAIDS to introduce routine 'opt out' HIV testing in countries with high prevalence. A number of claims have been made with regard to the benefits of increasing the numbers of people on antiretroviral therapy. Two of these claims are disputed here. Treatment roll-out and the associated push for routine testing raise questions of concern to public health and human rights. While it is claimed that treatment roll-out will reduce stigma and discrimination, there is little evidence to support the claim. It is also claimed that treatment uptake will reduce the likelihood of HIV transmission and that thus treatments themselves have a preventive effect. This direct effect of treatment uptake on prevention is augmented, it is claimed, if use is made of the voluntary counselling and testing (VCT) encounter and people counselled to act safely. Again there is little evidence to support the claims made. In addressing the evidence for these two claims, the paper cautions against the large scale adoption of routine 'opt out' or, as it is sometimes called, 'provider-initiated' testing.
Anti-HIV Agents↗
Some characteristics of early-onset injection drug users prior to and at the time of their first injection.
AIMS: This paper examines differences between early- and late-onset injection drug users (12-16 years versus 17-24 years) in terms of the antecedents and circumstances of first injection. DESIGN: Cross-sectional retrospective design, using logistic regression. Setting Australia: Sydney, Brisbane, rural New South Wales. PARTICIPANTS: A total of 336 injection drug users aged 16-25 years at the time of interview. MEASUREMENTS: Independent variables included family injection drug use, homelessness and other demographic variables, drugs used prior to the first injection, length of pre-injection drug career, behaviours at time of first injection (e.g. drug injected, reasons/motives for the first injection, risk behaviours). FINDINGS: Early-onset injection was associated independently with: having a family who injected drugs, having left school early, an unreliable source of income, a short pre-injection drug career, planning of the first injection, reliance on others for administration of the first injection and denial that experimentation was the motive for the first injection. In bivariate analysis, early-onset injection was associated further with: homelessness, being an Indigenous Australian, omission of use of certain pre-injection drugs, group presence at first injection, reliance on others for acquisition of the first needle and syringe and having injected the first time because an injection was offered. CONCLUSIONS: The research shows that early-onset, compared with late-onset injectors, are more likely to have an immediate family who inject drugs and other problematic beginnings in early life. They have an accelerated transition to injection, and differences in autonomy and motivation at first injection. These characteristics may make them more vulnerable to risk taking.
Adolescent↗
Factors associated with 'feeling suicidal': the role of sexual identity.
This paper examines factors associated with feeling suicidal in a large sample of urban men in Sydney and Melbourne, aged 18-50, including heterosexual, gay and bisexual men, HIV antibody positive and HIV antibody negative. As in previous research, sexuality (being homosexual or bisexual) was found to be a major predictor of suicidality. The research went some way towards explaining the close relationship between feeling suicidal and sexual orientation. Sexuality interacts with feeling bad in that, once men feel moderately bad/depressed, they are more likely to feel suicidal if they are homosexual or bisexual than if they are heterosexual. In addition, the research found that experience of verbal abuse and physical assault (harassment) increased feeling suicidal for both heterosexual and gay/bisexual men, not just for homosexual men as suggested by previous research, and that social isolation in the form of living alone is a further risk factor. Seeking counseling help and taking sexual risks were also independently associated with feeling suicidal. These actions may result from feeling suicidal rather than the reverse, and their association with feeling suicidal warrants further research. Many of the 46 independent variables examined in the research, including HIV antibody status and closeness to the HIV/ AIDS epidemic, were related to feeling suicidal only through their association with being gay/bisexual. Celibacy and general risk taking were not related to feeling suicidal in this study.
Adolescent↗
A national sexually transmissible infections strategy: the need for an all-embracing approach.
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Adolescent↗
Undetectable viral load is associated with sexual risk taking in HIV serodiscordant gay couples in Sydney.
OBJECTIVE: 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. METHOD: A cross-sectional study nested within two cohort studies, the Health in Men (HIM) cohort of HIV-negative men, from July 2001 to December 2003 and the Positive Health (PH) cohort of HIV-positive men, from February 2002 to August 2003. The study participants were 119 men in an HIV serodiscordant regular relationship of at least 6 months duration (45 HIV-negative men from HIM, 74 HIV-positive men from PH). The main outcome measure was the occurrence of UAI within the relationship in the previous 6 months. RESULTS: Eighty-two men reported no UAI and 37 reported some UAI. Of couples in which the HIV-positive partner's viral load was reported to be undetectable, 39.4% reported UAI compared with 20.8% of those where viral load was reported to be detectable (P = 0.04). In multivariate analysis, significant predictors of UAI were younger age [odds ratio (OR), 0.94; 95% confidence interval (CI), 0.87-1.00; P = 0.05], greater HIV optimism (OR, 4.98; 95% CI, 1.25-19.8; P = 0.02) and reported undetectable viral load (OR, 2.88; 95% CI, 1.13-7.37; P = 0.03). CONCLUSIONS: Most serodiscordant gay couples do not engage in any UAI. UAI within such relationships is significantly more likely to occur where the HIV-positive partner is reported to have undetectable viral load. UAI in HIV serodiscordant relationships is problematic even if viral load is undetectable because of unknown risk parameters, viral load variability and the possibility of drug-resistant strains of HIV.
Adult↗
Stability and change in sexual practices among first-year Australian university students (1990-1999).
A questionnaire on sexual attitudes and behavior was administered to first-year students at Macquarie University in Sydney every year from 1990 to 1999 (N = 4295 aged 18-19; 72.5% female). Responses to questions about experience of different sexual practices (tongue kissing, oral sex, and vaginal intercourse) with regular and casual partners were analyzed for trends. Over half of the students each year (on average 64% of the men, 57% of the women) had experience of oral sex or vaginal intercourse. More male than female students reported experience of each practice, especially with casual partners. Rates for female students increased significantly over the 10-year period for all practices except tongue kissing with a regular partner and vaginal sex with a casual partner; rates for male students were apparently steady. Results are consistent with evidence from other sources of an increase in the acceptability of oral sex (both fellatio and cunnilingus) in recent decades and of increasing similarity between young men's and women's reports of sexual experience.
Adult↗
Sexual behaviour and human herpesvirus 8 infection in homosexual men in Australia.
BACKGROUND: 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. METHODS: We conducted a prospective cohort study of 179 homosexual men in Sydney Australia in 1992-1998. Detailed data on sexual behaviour was collected annually, and HHV-8 status was determined at the end of the study by an algorithm based on results of an immunofluorescence assay and an enzyme-linked immunoassay to the K8.1 protein of HHV-8. HHV-8 DNA was detected in buffy coats using a nested qualitative PCR. RESULTS: Data on sexual behaviour in at least three interviews and HHV-8 status were available in 174 (97%) of 179 men who agreed to participate. Of these, 31 (18%) were HHV-8 seropositive, and HHV-8 DNA was detected in 5 (16%) of these. The prevalence of HHV-8 infection was much higher in HIV positive (52%) than HIV negative (11%) men (OR 8.60, 95% CI 3.55-20.86). HHV-8 infection was related to more frequent reporting of unprotected receptive anal sex (OR for most frequent versus least frequent category 3.03, 95% CI 1.01-9.03, P trend 0.02), insertive oro-anal sex (OR for most frequent v. least frequent category 3.02, 95% CI 1.15-7.93, P trend 0.02) and receptive oro-anal sex (OR for most frequent v. least frequent category 3.09, 95% CI 1.11-8.60, P trend 0.05) with casual partners. CONCLUSIONS: These data are consistent with sexual transmission of HHV-8, but the precise mode of HHV-8 transmission remains unclear. Studies to elucidate the precise mode of sexual transmission of HHV-8 need to focus on potential salivary transmission, and should collect data on the HHV-8 infection and excretion status of the sexual partner.
Adult↗
How has the sexual behaviour of gay men changed since the onset of AIDS: 1986-2003.
OBJECTIVE: To report changes in sexual behaviour among gay men in Sydney from 1986 to 2003. METHODS: Baseline data from four studies of gay men in Sydney were used: the Social Aspects of the Prevention of AIDS study (1986/87: 91 HIV-positive and 444 HIV-negative men); the Sydney Men and Sexual Health cohort (1993-95: 237 HIV-positive and 910 HIV-negative men); the Health in Men cohort of HIV-negative gay men (2001-03: 1,148 men); the Positive Health cohort of HIV-positive gay men (2001/02: 237 men). Each sample was recruited and interviewed using similar methods. RESULTS: Fewer HIV-positive men had sex with casual partners over time (76.9% in 1986/87 to 63.7% in 2001/02; p = 0.001), but more HIV-negative men had sex with 10 or more casual partners in the previous six months (27.7% in 1986/87 to 37.7% in 2001-03; p = 0.012). The proportions engaging in particular sex practices with casual partners changed over time: anal intercourse without condoms that included ejaculation in the rectum fell from 29.4% among HIV-positive men and 32.4% among other men in 1986/87 to 17.8% and 10.0% respectively in 1993-95 (p = 0.034 and p < 0.001 respectively), but increased to 37.7% and 18.4% respectively in 2001-03 (p-values < 0.001); rimming one's partner increased from 36.8% among HIV-positive men and 17.6% among other men in 1986/87 to 63.6% and 52.3% respectively in 2001-03 (p = 0.001 and p < 0.001 respectively). CONCLUSION: Gay men's sexual behaviour with casual partners has changed over time, perhaps partly in response to HIV and partly as a general expansion of sexual repertoires. These changes have implications for gay men's health.
Adult↗
Willingness to participate in HIV vaccine trials among HIV-negative gay men in Sydney, Australia.
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.
AIDS Vaccines↗
Modeling trends in HIV incidence among homosexual men in Australia 1995-2006.
BACKGROUND: 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. METHODS: A mathematical model of HIV transmission among homosexual men in Australia was developed. HIV incidence during 1995-2001 was estimated assuming that 70% of men in whom HIV was diagnosed received ARVs and assuming a 10% annual increase in UAIC. For 2001-2006, scenarios included ARV levels remaining at 70% or declining to 50% by 2006, combined with UAIC levels remaining at the 2001 level or continuing to increase annually by 10%. FINDINGS: The number of incident HIV cases per year was predicted to have declined during 1996-1998 due to the introduction of effective ARVs, with a slow increase during 1998-2001 due to increased levels of UAIC when use of therapies was fairly stable. From 2001, a continued increase in UAIC was predicted to lead to a rise in HIV incidence. A rise in UAIC combined with a moderate decline in ARV use could lead to a 50% increase in HIV incidence by 2006. INTERPRETATION: These models suggest that widespread ARV use has had some effect in reducing HIV incidence among homosexual men in Australia. However, if current trends in UAIC and ARV use continue, a resurgent HIV epidemic is predicted.
Anti-Retroviral Agents↗
'I didn't think I was at risk': Interdiscursive relations in narratives of sexual practices and exposure to HIV.
This article is concerned with the discursive construction of sexual practices and 'risk' in gay men's accounts of exposure to HIV. The data are in-depth interviews from two Sydney-based studies. While the events reported in both studies were very similar, there are considerable differences in the language choices. Drawing on critical discourse analysis and systemic functional linguistics, this paper shows how language choices in individual narratives resonate intertextually with the public health discourse of safe sex, which emphasizes knowledge of safe sex, control over sexual practices and condom use. While in accounts of exposure to HIV in the context of prevention sexual practice is construed consistently as 'doing' with the speakers as Actor, in accounts of exposure to HIV in the context of transmission it is construed predominantly as 'thinking' and 'being'. There are also differences in the negotiation of alternatives. All narratives resonate with the discourse of safe sex, however, it is not passively reflected in speech but is actively engaged with and shaped to fit the knowledge and understanding of individuals. The narratives also resonate with the private world of intimate relationships and everyday life. This suggests a notion of 'risk' as a hybrid of multiple, potentially conflicting discourses.
Alcoholic Intoxication↗
HIV transmission among gay men through oral sex and other uncommon routes: case series of HIV seroconverters, Sydney.
Seventy-five homosexual men with recently acquired HIV were interviewed about their risk behaviour. Fifty-nine reported unprotected anal intercourse, and one shared injecting equipment, with a partner not known to be HIV negative. Of the remaining 15, 11 reported protected anal intercourse. In five of the 15 we judged oral sex to be the most likely source of infection, including three men who had a genital piercing. The possible transmission risk from genital piercing should be investigated.
Cohort Studies↗
Sustaining safe practice: twenty years on.
This paper examines the ways in which populations at risk of HIV in the developed world have enculturated the knowledges and technologies of both the medical and the social sciences. By revisiting a number of review papers and by reviewing findings from a range of studies, we argue that gay men have appropriated information that has enabled them to sustain safe practices while they have eschewed information that has made maintenance difficult. The paper describes a range of risk reduction strategies and compares the responses of populations at risk of HIV in the years before the advent of highly active antiviral therapy (HAART) with their responses after the introduction of HAART in 1996. We concentrate our argument on the changing responses to HIV risk of gay men, although occasionally illustrate our argument with reference to the responses of injecting drug users. The responses of gay men to risk post-HAART--particularly those who reside in Australia--speak to the adoption of a range of considered strategies, not altogether safe, to reduce harm. We argue that such strategies need to be understood and addressed within a 'new' social public health, that is, a public health that takes what social analysis has to say seriously. The paper examines the differences between the traditional, the 'modern' epidemiological/clinical and the 'new' social or socio-cultural public healths and describes the tensions between the medical and the social science disciplines in their efforts to inform public health. Key concepts provided by social science such as agency (including individual and collective agency), alongside its methodological reflexivity are key to effective public health. The risk avoidance strategies adopted by gay men suggest a way forward by turning our attention to the ways in which medicine is taken in(to) their practice.
Antiretroviral Therapy, Highly Active↗
The injection of methadone syrup in New South Wales: patterns of use and increased harm after partial banning of injecting equipment.
OBJECTIVE: To describe methadone injectors and the risk practices associated with injecting methadone in New South Wales, Australia. To assess the impact on injecting drug use and risk behaviour of the withdrawal of methadone injecting equipment from government-funded needle and syringe programs. METHOD: Cross-sectional survey, conducted in 1999, of 206 people who had injected methadone at least once in the previous month. Participants were from Central Sydney, West Sydney and rural New South Wales. RESULTS: Of participants who had injected both methadone and other drugs in the previous month (n=162), significantly more reused their methadone injecting equipment compared with those who reused their other drug injecting equipment (60% vs. 28%, p<0.01). There was no significant difference in terms of sharing injecting equipment, with 19% reporting sharing methadone injecting equipment and 14% sharing other drug injecting equipment. However, women were more likely than men to share methadone injecting equipment. Over half of the participants had accessed diverted methadone and a substantial minority reported the use of public spaces for injecting methadone. CONCLUSIONS: Our results suggest that the current policy has led to increased reuse of equipment for injecting methadone. IMPLICATIONS: A range of other possible policy options, such as closer monitoring and dilution of take-home doses, increasing oral doses and implementing trials of injected methadone, may assist to reduce the prevalence of methadone syrup injection and related harms.
Administration, Oral↗
Editorial introduction. HIV/AIDS prevention and education in context: current perspectives, future challenges.
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Developed Countries↗