Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections

Sexual Health ◽  
2011 ◽  
Vol 8 (3) ◽  
pp. 272 ◽  
Author(s):  
Iryna B. Zablotska ◽  
Susan Kippax ◽  
Andrew Grulich ◽  
Martin Holt ◽  
Garrett Prestage
Keyword(s):  
Gay Men ◽  
Warning System ◽  
Anal Intercourse ◽  
Policy Implications ◽  
Cross Sectional ◽  
Sti Prevention ◽  
Gay Community ◽  
Behavioural Surveillance ◽  
Sexually Transmissible Infections ◽  
Over Time

Background 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. Methods:We describe the design and history of GCPS. For analyses of indicators, we use Pearson’s χ2-test and test for trend where appropriate. Results: About 90% of gay men in Australia have been tested for HIV (60% to 70% of men who were not HIV-positive) have been tested as recommended in the preceding 12 months. STI testing levels (~70% in the preceding 12 months) are high, but remain insufficient for STI prevention. In general, unprotected anal intercourse with regular (UAIR) and casual (UAIC) sex partners has increased over time. The prevalence and increasing trends in UAIR were similar across jurisdictions (P-trend <0.01), while trends in UAIC differed across the states: during 2001–08, UAIC declined in NSW (P-trend <0.01) and increased elsewhere (P-trend <0.01). Trends in UAIC were associated with HIV diagnoses. Conclusion: This review of the design, implementation and findings of the Australian HIV/STI behavioural surveillance highlights important lessons for HIV/STI behavioural surveillance among homosexual men, particularly the need for consistent data collection over time and across jurisdictions. Investment in systematic behavioural surveillance appears to result in a better understanding of the HIV epidemic, the availability of a warning system and a better targeted HIV prevention strategy.

30. TESTING FOR SEXUALLY TRANSMISSIBLE INFECTIONS AMONG GAY MEN IN SYDNEY, AUSTRALIA

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 296 ◽  
Author(s):  
G. Prestage ◽  
I. Zablotska ◽  
A. Frankland ◽  
J. Imrie ◽  
A. Grulich
Keyword(s):  
Gay Men ◽  
Urine Sample ◽  
Blood Test ◽  
Throat Swab ◽  
Anal Intercourse ◽  
Unprotected Anal Intercourse ◽  
Gay Community ◽  
Sti Testing ◽  
Sexually Transmissible Infections ◽  
Anal Swab

Introduction: Recently, rates of sexually transmissible infections (STIs) have been increasing among gay men in Australia and elsewhere. We explored trends in STI testing among gay men in Sydney. Methods: We used behavioural data from the six-monthly Sydney Gay Community Periodic Survey (SGCPS). Men are recruited through gay community venues, clinics and events in Sydney. Since 2003 men were asked whether they had received the following tests in the previous year: Anal swab, throat swab, penile swab, urine sample, and blood test for STIs other than HIV. Men recruited from clinics were excluded from the following analyses. Results: In 2006, 3145 completed questionnaires were received from non-clinic sites, with 40.9% of respondents reporting having received an anal swab, 45.4% a throat swab, 34.6% a penile swab, 52.7% a urine sample, and 56.1% a blood test for STIs other than HIV. The majority (67.2%) reported at least one test for STIs, with 25.5% having received all five forms of STI test. Although there was no increase during 2003-2006 in having any STI tests, the proportion of men having received all five types of test increased. The largest increase was in the proportion reporting anal swabs: from 23.8% in 2003 to 40.9% in 2006. Among men reporting unprotected anal intercourse with casual partners (UAIC), as well as among men with more than ten casual partners in the previous six months, rates of STI testing were higher but the time trends were similar. Conclusion: The majority of men report STI testing in the previous year, and this testing has become more comprehensive, with men receiving a broader range of STI tests over time. Men at higher risk for STIs tested at increased rates.

27. CAN UNPROTECTED ANAL INTERCOURSE WITH REGULAR AND CASUAL PARTNERS EXPLAIN THE DIVERGING TRENDS IN HIV EPIDEMIC IN AUSTRALIA?

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 295
Author(s):  
I. Zablotska ◽  
G. Prestage ◽  
A. Grulich ◽  
J. Imrie ◽  
S. Kippax
Keyword(s):  
Gay Men ◽  
Anal Intercourse ◽  
Unprotected Anal Intercourse ◽  
Unprotected Sex ◽  
Cross Sectional ◽  
Gay Community ◽  
Hiv Epidemic ◽  
Hiv Serostatus ◽  
Policies And Programs ◽  
Self Administered Questionnaire

Introduction: Worldwide, increases in unprotected anal intercourse have been linked to the resurgence in HIV and STI in gay men. We assessed whether changes in UAI within regular and casual relationships may explain the diverging trends in HIV in three Australian states - NSW, Victoria and Queensland. Methods: We used the data from the annual cross-sectional Gay Community Periodic Surveys conducted annually in Sydney since 1996 and in Melbourne and Queensland since 1998. A short self-administered questionnaire asks about HIV serostatus, sexual health testing and behaviours relevant to HIV epidemic. We present time trends in seroconcordance and unprotected sex with regular and casual partners. Results: Currently, about one third of gay men report being in monogamous regular relationships, and this proportion has been slowly increasing everywhere. The self-reported UAI with regular partners (UAIR) was highest among men in seroconcordant positive relationships, lower among seroconcordant negative partners and lowest in non seroconcordant relationships. From 1998 to 2006, the rates of UAIR consistently increased by 10% in all three states and in all relationships by serostatus. The rates of UAI with casual partners (UAIC) were historically highest in NSW. From a peak in 2001, UAIC rates have consistently declined in NSW, but continuing increases were observed in Victoria and Queensland. Higher rates of nondisclosure of HIV were also observed in the context of UAIC in the latter two states. Conclusion: Changes in unprotected sex with casual partners may be responsible for the slowing of HIV epidemic in NSW. Sustained investment in policies and programs are important in achieving behaviour change.

scholarly journals Risk behaviour among Aboriginal and Torres Strait Islander gay men: comparisons with other gay men in Australia

Sexual Health ◽  
2006 ◽  
Vol 3 (3) ◽  
pp. 163 ◽  
Author(s):  
Chris G. Lawrence ◽  
Patrick Rawstorne ◽  
Peter Hull ◽  
Andrew E. Grulich ◽  
Scott Cameron ◽  
...  
Keyword(s):  
Drug Use ◽  
Gay Men ◽  
Torres Strait Islander ◽  
Illicit Drugs ◽  
Risk Behaviour ◽  
Anal Intercourse ◽  
Cross Sectional ◽  
Gay Community ◽  
Increased Risk ◽  
Torres Strait

Objectives: 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. Methods: The Gay Community Periodic Survey is a repeated cross-sectional prevalence study of the sexual and drug use behaviours of Australian gay men conducted since 1996. Responses from Aboriginal and Torres Strait Islander (ATSI) gay men were compared with those from non-ATSI gay men for the years 2000–2004. Results: Of 34 708 responses collected in major Australian cities over a 6-year period, 1208 identified as Aboriginal or Torres Strait Islander. There was little difference between ATSI and non-ATSI men in the reported prevalence of HIV, though ATSI gay men were more likely than non-ATSI gay men to engage in unprotected anal intercourse with casual partners and to inject illicit drugs but were more likely to have been recently tested for HIV. Conclusions: These ATSI gay men were at increased risk of HIV and other blood-borne viruses, though this may be due to differences in socio-economic status as much as cultural background. These findings indicate the continued need for targeted sexual and injecting-drug-use health interventions among this population.

Condoms for sexually transmissible infection prevention: politics versus science

Sexual Health ◽  
2008 ◽  
Vol 5 (1) ◽  
pp. 1 ◽  
Author(s):  
Adrian Mindel ◽  
Shailendra Sawleshwarkar
Keyword(s):  
Scientific Data ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Sti Prevention ◽  
Degree Of Protection ◽  
Sexually Transmissible Infections ◽  
The Usa ◽  
Simplex Virus ◽  
The Impact ◽  
Abstinence Only

The present review assesses the protection that condoms offer against sexually transmissible infections (STI) and the impact that social, political and religious opinion in the USA has had in the past 8 years on promoting condoms for safer sex. Condoms offer protection against most STI. However, the degree of protection depends on correct and consistent use, the type of sexual activity and the biological characteristics of different infections. Cross-sectional and case-control studies and other observational data provide the majority of evidence for STI prevention. Condoms provide a high level of protection against those infections that are transmitted mainly via infected secretions, including HIV, gonorrhoea, chlamydia and trichomoniasis. Protection against those infections transmitted via skin and mucous membrane contact, including Herpes simplex virus infection and human papilloma virus, appears to be less. The Bush administration, driven by conservative political, social and religious elements in the USA, has mounted a concerted campaign to undermine the role of the condom in health-promotion activities in the USA and overseas by undervaluing and misrepresenting scientific data, and through a sustained and well-funded promotion of abstinence-only education. However, this has lead to considerable controversy and disillusionment with abstinence-only education, both at home and abroad, and there is now incontrovertible evidence that abstinence-only programs are ineffectual.

scholarly journals The Not-So-Marginal Value of Weather Warning Systems

2017 ◽  
Vol 10 (1) ◽  
pp. 89-101
Author(s):  
Benjamin M. Miller
Keyword(s):  
Fixed Effects ◽  
Warning System ◽  
Warning Systems ◽  
Policy Decisions ◽  
Cross Sectional ◽  
Marginal Value ◽  
Causal Impact ◽  
Over Time

Abstract Knowing the benefits of creating or expanding programs is important for determining optimal levels of investment. Yet estimates of the benefits of weather warning systems are sparse, perhaps because there is often no clear counterfactual of how individuals would have fared without a particular warning system. This paper enriches the literature and informs policy decisions by using conditional variation in the initial broadcast dates of the National Oceanic and Atmospheric Administration’s Weather Radio All Hazards (NWR) transmitters to produce both cross-sectional and fixed effects estimates of the causal impact of expanding the NWR transmitter network. Results suggest that from 1970 to 2014, expanding NWR coverage to a previously untreated county was associated with an almost 40% reduction in injuries and as much as a 50% reduction in fatalities. The benefits associated with further expansion of this system have likely declined over time.

Community event-based outreach screening for syphilis and other sexually transmissible infections among gay men in Sydney, Australia

Sexual Health ◽  
2013 ◽  
Vol 10 (4) ◽  
pp. 357 ◽  
Author(s):  
Phillip J. Read ◽  
Vickie Knight ◽  
Christopher Bourne ◽  
Rebecca Guy ◽  
Basil Donovan ◽  
...  
Keyword(s):  
Gay Men ◽  
Diagnostic Yield ◽  
Outreach Program ◽  
Computer Assisted ◽  
Gay Community ◽  
Sti Testing ◽  
Sexually Transmissible Infections ◽  
Important Addition ◽  
Testing Environments ◽  
The Cost

Objectives Increased testing frequency is a key strategy in syphilis control, but achieving regular testing is difficult. The objective of this study is to describe a sexually transmissible infection (STI) testing outreach program (the Testing Tent) at a gay community event. Methods: Gay men attending the testing tent in 2010–11 completed a computer-assisted self-interview and were screened for STIs. Clinical, demographic, behavioural and diagnostic data were compared with gay men attending a clinic-based service during 2009. The Testing Tent was marketed on social media sites and data were extracted on the number of times the advertisements were viewed. Staffing, laboratory, marketing and venue hire expenses were calculated to estimate the cost of delivering the service. Results: Ninety-eight men attended the Testing Tent. They were older (median age: 42 years v. 30 years; P < 0.001), had more sex partners (median: five in 3 months v. two; P < 0.001) and more likely to inject drugs (9% v. 4%; P = 0.034) than the 1006 clinic attendees, but were more likely to have previously tested for STIs (81% v. 69%; P = 0.028) and to always use condoms for anal sex (59% v. 43%; P = 0.005). Five cases of STIs were detected; the diagnostic yield was not significantly different from that of the clinic. The cost of the Testing Tent was A$28 440. Conclusion: Nonclinical testing facilities are an acceptable option and are accessed by gay men requiring regular testing, and may be an important addition to traditional testing environments.

Increasing gay men’s testing rates and enhancing partner notification can reduce the incidence of syphilis

Sexual Health ◽  
2012 ◽  
Vol 9 (5) ◽  
pp. 472 ◽  
Author(s):  
Ian Down ◽  
David P. Wilson ◽  
Pol Dominic McCann ◽  
Richard Gray ◽  
Alexander Hoare ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Gay Men ◽  
Online Survey ◽  
Partner Notification ◽  
Population Level ◽  
Anal Intercourse ◽  
Syphilis Infection ◽  
Substantial Impact ◽  
Syphilis Testing ◽  
Sexually Transmissible Infections

Background We sought to determine whether gay men would be willing to increase syphilis testing and partner notification, and assessed the possible epidemiological impact these changes might have in the Australian population. Methods: We conducted an online survey (n = 2306) and focus groups to determine whether interventions to increase testing for syphilis and enhanced partner notification are likely to be acceptable to gay men in Australia. An individual-based mathematical model was developed to estimate the potential population-level impact of changes in these factors. Results: Of all men surveyed, 37.3% felt they should test more frequently for sexually transmissible infections. Men who recent unprotected anal intercourse with casual partners and men who reported a higher number of partners were more likely to indicate a greater willingness to increase testing frequency. HIV-positive men were more likely to indicate that their frequency of syphilis testing was adequate, incorporated as part of their regular HIV monitoring. Lack of convenience was the main barrier reported. Partner notification was broadly acceptable, although perceived stigma presented a potential barrier. The mathematical model indicated that increasing testing rates would have a substantial impact on reducing rates of syphilis infection among gay men and partner notification would further reduce infections. Conclusions: Interventions promoting testing for syphilis among gay men and increases in partner notification may be acceptable to gay men and are likely to result in decreased infection rates. Rapid testing and modern communication technologies could strengthen these interventions, and have an impact on the syphilis epidemic.

Improvements in sexual health testing among gay men in Sydney, Australia, 2003–2007

2008 ◽  
Vol 19 (11) ◽  
pp. 758-760 ◽  
Author(s):  
I B Zablotska ◽  
J Imrie ◽  
C Bourne ◽  
A E Grulich ◽  
A Frankland ◽  
...  
Keyword(s):  
Gay Men ◽  
Prevalence Ratio ◽  
Anal Intercourse ◽  
Unprotected Anal Intercourse ◽  
Hiv Positive ◽  
Transmitted Infection ◽  
Gay Community ◽  
Sti Testing ◽  
Risk Practices ◽  
Hiv Negative

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.

28. RISK TAKING AND SAFER SEX PRACTICES IN CASUAL RELATIONSHIPS BETWEEN MEN

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 295
Author(s):  
I. Zablotska ◽  
A. Frankland ◽  
G. Prestage ◽  
A. Grulich ◽  
J. Imrie
Keyword(s):  
Gay Men ◽  
Hiv Transmission ◽  
Casual Sex ◽  
Hiv Positive ◽  
Strategic Positioning ◽  
Gay Community ◽  
Hiv Serostatus ◽  
Over Time ◽  
Hiv Negative ◽  
Hiv Positive Men

Introduction: Universal condom use in casual sex is unlikely. We explored whether gay men lower the risk of HIV transmission during unprotected anal intercourse with casual partners (UAIC) by disclosing HIV serostatus and engaging in lower risk practices such as strategic positioning and/or withdrawal. Methods: We used data from the annual cross-sectional Sydney Gay Community Periodic Survey. A short self-administered questionnaire collects information about HIV serostatus of the respondents, sexual practices with other men and other HIV-relevant behaviours. We present the prevalence of and time trends in disclosure of serostatus and the use of strategic positioning and withdrawal with casual partners. Results: In 2006, 2568 men reported having had a casual partner in the 6 months before the survey. Disclosure was higher among men engaging in UAIC (68.4%) compared to those who always used condoms (49.7%). This relationship was more apparent amongst HIV-positive than negative men, of whom 83.5% and 63.9%, respectively, reported any disclosure. Over time, HIV-positive and negative men have increasingly reported disclosing to 'all' of their casual partners (p�<�0.01). HIV-positive men were less likely to report insertive-only positioning during UAIC (8.9%) compared to HIV-negative men (39.2%), with no changes emerging since over time. Significant increases were also noted in the proportion of HIV-positive men reporting withdrawal during insertive-UAIC (p�<�0.001) and HIV-negative men reporting withdrawal during receptive-UAIC (p�<�0.001). Conclusion: In the context of UAIC, gay men appear to be employing a range of risk-reduction strategies. Increasing levels of disclosure and/or practices such as strategic positioning and withdrawal demonstrate the complexity of gay men's construction of, and engagement with, risk associated with HIV transmission. A more thorough understanding of these practices is essential for ongoing education and prevention.

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