Age related factors influence HIV testing within subpopulations: a cross sectional survey of MSM within the Celtic nations

Objectives: Despite a recent fall in the incidence of HIV within the UK, men who have sex with men (MSM) continue to be disproportionately affected. As biomedical prevention technologies including pre-exposure prophylaxis are increasingly taken up to reduce transmission, the role of HIV testing has become central to the management of risk. Against a background of lower testing rates among older MSM, this study aimed to identify age-related factors influencing recent (≤12 months) HIV testing. Methods: Cross-sectional subpopulation data from an online survey of sexually active MSM in the Celtic nations—Scotland, Wales, Northern Ireland and Ireland (n=2436)—were analysed to compare demographic, behavioural and sociocultural factors influencing HIV testing between MSM aged 16–25 (n=447), 26–45 (n=1092) and ≥46 (n=897). Results: Multivariate logistic regression demonstrated that for men aged ≥46, not identifying as gay (OR 0.62, CI 0.41 to 0.95), location (Wales) (OR 0.49, CI 0.32 to 0.76) and scoring higher on the personalised Stigma Scale (OR 0.97, CI 0.94 to 1.00) significantly reduced the odds for HIV testing in the preceding year. Men aged 26–45 who did not identify as gay (OR 0.61, CI 0.41 to 0.92) were also significantly less likely to have recently tested for HIV. For men aged 16–25, not having a degree (OR 0.48, CI 0.29 to 0.79), location (Republic of Ireland) (OR 0.55, CI 0.30 to 1.00) and scoring higher on emotional competence (OR 0.57, CI 0.42 to 0.77) were also significantly associated with not having recently tested for HIV. Conclusion: Key differences in age-related factors influencing HIV testing suggest health improvement interventions should accommodate the wide diversities among MSM populations across the life course. Future research should seek to identify barriers and enablers to HIV testing among the oldest and youngest MSM, with specific focus on education and stigma

Understanding and responding to remote mental health help-seeking by gay, bisexual and other men who have sex with men (GBMSM) in the U.K. and Republic of Ireland : a mixed-method study conducted in the context of COVID-19

Background: Gay, bisexual and other men who have sex with men (GBMSM) are at far greater risk of experiencing poor mental health (MH) than wider society. This disparity was exacerbated by additional unique to sexual minority status' COVID-19 stressors. Objective: This sequential, mixed-methods study examined remote MH help-seeking among GBMSM in the U.K. and Ireland during the first COVID-19 lockdown. Methods and Results: Quantitative survey data (n = 1368), analysed with logistic regression, suggested GBMSM experiencing moderate-to-severe anxiety and those with a past MH diagnosis were most likely to seek MH support. Thematic analysis of qualitative interview (n = 18) data identified multiple barriers and enablers to GBMSM seeking remote MH help, with the help primarily sought from GBMSM-facing organisations and generic online resources. Finally, the behaviour change wheel was used to generate theoretically informed recommendations to promote MH help-seeking among GBMSM in Scotland. Implications: We discuss how applying these recommendations in the short, medium and long term will begin to address GBMSM's MH needs, post COVID-19

Health promotion within a public sex environment : exploring sexual cultures, health and behaviours

This thesis collects together six peer review papers which i) examine the sexual (health) behaviours of men who 'cruise' public sex environments (PSEs) to engage in sex with men and ii) evaluate sexual health outreach conducted therein. It is based partly upon a year long, mixed methods evaluation of the 'Street Outreach Service', which provides sexual health promotion to men who have sex with men within one large PSE in southern England. The first chapter introduces this work, demonstrating the interrelationship of the submitted publications through a critical analysis. Chapter two presents our systematic review of quantitative PSE literature which, while suggesting high sexual health risks within PSEs, revealed serious methodological shortcomings of the established evidence base. Next, three quantitative data driven papers are presented which detail the results of our in situ PSE survey, which demonstrated far greater methodological rigour than previous quantitative research. In chapter three, the sexual risk behaviours, HIV testing and infection rates of PSE users are examined. High HIV testing and prevalence were found, along with patterns of sexual risk taking which highlighted the importance of in situ targeted HIV prevention. Chapter four considers the wider sexual health of PSE users focusing on their experiences of STIs other than HIV. Our study suggested that whilst PSEs do not represent centres of endemic STI transmission, users' sub-optimal STI clinic attendance and frequent sexual contacts may mask undiagnosed infection. Evaluating an established health promotion intervention precludes the generation of baseline data necessary for randomised controlled trial evaluation. Consequently, chapter five investigates the value of 'contact efficacy' to evaluate ongoing service provision where no baseline data exist, employing one-off, cross-sectional survey data. Contact efficacy provided a useful means to assess this established health intervention, though since causality cannot be inferred from the design, triangulation of results with other evaluative methodologies was recommended. Indeed, by bringing together survey, interview and systematic review data, this thesis demonstrates value of such triangulation. However quantifying the frequency of PSE sexual acts only confirms that behavioral risks occur. A more critical sexual health psychology argues that, in order to develop culturally appropriate health interventions, we need to understand both the social organisation in which such risks occur and the opportunities to negotiate sexual interactions therein. Therefore, the final two papers within this thesis focus on experiential aspects of PSE- based sexual health promotion, to explore the value of sexual cultures theory in understanding PSE behaviours and in situ health promotion. In chapter six, our systematic review of qualitative PSE research argues that a generic, shared PSE sexual culture emerges from the literature, across locations, countries and decades, due to the importance of concealment and common structural constraints upon PSEs sex. However, differences in local geography and facilities may transform key features of this, resulting in specific, local sexual cultures emerging for individual locales. The closing chapter analyses interviews with outreach workers, volunteers and PSE users to explore how respecting these local sexual cultures is central to the success of innovative in situ PSE sexual health promotion. In conclusion, the central argument of this thesis is that whilst PSEs likely represent sites of increased STI transmission through high partner availability and disassortative sexual mixing, sexual health outreach therein must respect the local sexual cultures for acceptability and success. Moreover, this work demonstrates the importance of, and strengthens the evidence base for, targeted PSE-based sexual health promotion.EThOS - Electronic Theses Online ServiceGBUnited Kingdo