‘It’s like I have this weird superpower’: experiences of detectable and undetectable viral load among a cohort of recently diagnosed people living with HIV.

Background: By reducing HIV viral load to undetectable levels, HIV treatment slows disease progression and eliminates the possibility of sexual transmission. The promotion of undetectable viral load has also been accompanied by expectations of reducing HIV-related stigma, including self-stigma. Drawing on accounts of people recently diagnosed with HIV, we explored experiences of both detectable and undetectable viral load. Methods: Between January 2019 and November 2021, semi-structured interviews were conducted with 35 people living with HIV (PLHIV) who had received an HIV diagnosis in Australia from 2016 onward. Of these participants, 24 completed follow-up interviews approximately 12 months later. Interviews were transcribed verbatim, entered into NVivo (software v12), and thematically analysed. Results: Reflecting on the period in which their viral load was detectable, some participants described feeling ‘dirty,’ ‘viral,’ and ‘a risk’ to sexual partners. During this period, some participants minimised or ceased having sex, sometimes despite being in ongoing romantic relationships. Reaching undetectable viral load was commonly characterised as an important goal in HIV care and signalled a marker of good health and enabled a return to sexual relationships. However, the psychosocial benefits of undetectable viral load were not universally experienced, with some participants highlighting ongoing challenges of living with HIV long term. Conclusions: Increasing awareness of the benefits of undetectable viral load is an important and powerful tool for improving the health and wellbeing of PLHIV; however, the period in which one’s HIV viral load is detectable can be challenging, particularly as feelings of being ‘unclean’ and ‘a risk’ may be internalised. Ensuring PLHIV are appropriately supported during periods of viral detectability is necessary

Gay community periodic survey: Melbourne 2015

This study finds that HIV testing by gay and bisexual men in Melbourne continues to increase. Executive summary The Melbourne Gay Community Periodic Survey is a cross-sectional survey of gay and homosexually active men recruited at a range of gay community sites in Melbourne. The major aim of the survey is to provide data on sexual, drug use, and testing practices related to the transmission of HIV and other sexually transmissible infections (STIs) among gay men. The most recent survey, the seventeenth in Melbourne, recruited a total of 3,006 men in January 2015. The majority of these men (n=2,429, 81%) were recruited using face-to-face recruitment by trained staff at gay social venues (e.g. bars and community organisations), sex-on-premises venues, sexual health clinics, and the Midsumma Carnival. The remaining 577 men (19%) participated through an online version of the survey. Online recruitment was conducted for the first time in 2015 through the social networking site Facebook. Men were directed to a website with an online version of the GCPS questionnaire (http://gcpsonline.net). The advertisements were targeted to all men aged 16 and above who were located in Victoria and indicated in their Facebook profile that they were ‘interested’ in men. From its start in 1998, the project has been funded by the Victorian Department of Health and supported by the Victorian AIDS Council and Living Positive Victoria. The Centre for Social Research in Health coordinates the survey, with support from the Kirby Institute. The overall response rate for the 2015 survey was 77%. The data presented in this report are from the period 2011 to 2015. Since 2011, there have been significant decreases in the proportions of men recruited at sexual health clinics, social venues, and the Midsumma Carnival. The proportion of men recruited from sex-on-premises venues has remained stable over time. The online sample was analysed before we incorporated it into the survey database. There were a number of differences between men recruited online and men recruited through venues and events. Men in the online sample were younger and were more likely to be born in Australia. Men in the online sample were also less likely to report testing for HIV in the 12 months prior to the survey and were more likely to report that they were HIV-negative. Compared to men recruited through physical venues, men recruited through online survey were more likely to be in a monogamous relationship and have condomless anal intercourse with their regular partner. They were also more likely to report condomless anal intercourse with casual partners and were less likely to know that PEP was available. The online and offline samples reported similar rates of STI testing and drug use. However, despite these differences, when we merged the online and offline samples, the majority of key indicators did not appear to be affected by the change in sampling methods. We have therefore incorporated the online sample into the combined database and the reporting of trends. We will, however, continue to monitor the impact of online recruitment on the sample over time

Off-Label Use of Phosphodiesterase Type 5 Inhibitor Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia: Results from the FLUX Study

Introduction: Gay and bisexual men (GBM) use erectile dysfunction medications (EDM) such as Viagra™, Cialis™ and Levitra™ often with little evidence of medical indication that might necessitate their use. Aim: We investigate the prevalence and contexts of, and motivations for, EDM use, and its relationship to sexual risk behavior. Method: Between September 2014 and July 2015, Australian GBM were invited to enroll online through social networking and gay community sites to complete a comprehensive survey looking at licit and illicit drug use and their associated behaviors. A total of 2250 GBM completed the questionnaire. Main outcome measures: Any EDM use, and at least weekly use in the previous six months. Results: Two thirds (67.7%) reported no history of EDM use in their lifetime. Approximately one in ten participants (11.1%) had last used EDM more than six months ago. In the previous six months, 11.5% reported using EDM less than monthly, 5.3% at least monthly, and 4.5% weekly or more often. Among men who had used EDM in the previous six months, the most common reasons cited for its use were: to maintain an erection for longer (73.3%), to make it easier to get hard (67.3%), and difficulty in attaining or maintain an erection (53.5%). Conclusion: While some GBM use EDM specifically for erectile dysfunction, many also use EDM to enhance their sexual experiences. Often, this occurs in the context of intensive sex partying, which may include risky sexual behavior. The use of EDM in the context of intensive sex partying (which include the combined use of EDM and illicit drugs), with the associated potential for increased risk of HIV transmission, indicates a need to consider the use of EDM among GBM in HIV prevention

The effect of pre-exposure prophylaxis (PrEP) on negotiating casual sex between gay men: disclosure, assumptions, and communication.

BACKGROUND: The disclosure of HIV status and pre-exposure prophylaxis (PrEP) use can be important in the negotiation of safe sex. With the rapid uptake of PrEP in Australia, norms and expectations about discussion and disclosure may have changed. METHODS: We explored the disclosure of PrEP use, HIV status and communication with sex partners by HIV-negative gay men in Sydney, Australia. We conducted semi-structured interviews from October 2017 to May 2018 and analysed data using a codebook thematic analysis approach. RESULTS: Participants had a variety of expectations of what they should tell their partners and what they expected in return. For some participants, PrEP had negated the need for any discussion about HIV. Many participants assumed their partners would find information about their HIV status or PrEP use on their online profiles or that partners would ask, if necessary. CONCLUSIONS: Building a stronger, shared understanding among gay men that disclosure and discussion no longer automatically occur before sexual encounters may be useful

Gay Community Periodic Survey: Sydney February 2008

Gay Community Periodic Surveys surveys are regularly conducted in Sydney, Melbourne, Brisbane, Cairns, Canberra, Adelaide and Perth to monitor changes in sexual and other risk practices over time among Australian gay men who are gay community attached, recruited from gay sex-on-premises venues, social sites and clinics

Patient-centred approaches to providing care at HIV diagnosis: perspectives from healthcare and peer-support workers

Background. Early uptake of HIV treatment among those newly diagnosed with HIV can improve individual health and prevent onward transmission. Patient-centred care is considered an important aspect in health care, the management of HIV, and can improve uptake of and adherence to HIV treatments. Methods. Semi-structured interviews were conducted with sexual health clinicians (n, 10) and HIV support workers (n, 4) to understand how they approached HIV diagnosis delivery and care immediately thereafter. Results. Our thematic analysis identified three themes: (1) centring patient needs at diagnosis; (2) assessing patients’ readiness to begin treatment; and (3) referrals to psychosocial support services. Our findings highlight centring patients was an important aspect of how participants delivered HIV diagnoses. By taking this approach, clinicians were best able to consider patient readiness to initiate treatment and referrals to social support services. Conclusions. Given HIV diagnoses are increasingly occurring in generalist health services, our findings offer an important opportunity to learn from the experiences of specialist sexual health clinicians and HIV support workers

Adjusting Behavioural Surveillance and Assessing Disparities in the Impact of COVID-19 on Gay and Bisexual Men’s HIV-Related Behaviour in Australia

COVID-19 has disrupted sexual behaviour and access to health systems. We adapted regular HIV behavioural surveillance of gay and bisexual men (GBM) in Australia in response to COVID-19, assessed the impact on the profile of the sample, the participants’ HIV-related behaviour, and whether COVID-19 may have accentuated existing disparities in the Australian HIV epidemic. Data collected from five states during July 2017–June 2021 were included (N = 31,460). The emphasis on online recruitment after COVID-19 led to smaller sample sizes, greater geographic reach, and a higher proportion of bisexual-identifying participants. Most participants (88.1%) reported physical distancing and 52.1% had fewer sex partners due to COVID-19. In the COVID-19-affected rounds (July 2020–June 2021), the number of male partners, recent HIV testing and pre-exposure prophylaxis (PrEP) use all fell, and HIV risk among the smaller group of participants who reported casual sex increased. COVID-related changes were generally more pronounced among GBM aged under 25 years, participants from suburbs with fewer gay residents, and bisexual men. These groups should be prioritised when encouraging GBM to reengage with HIV testing services and effective prevention methods, like condoms and PrEP

Asian Gay Men in Sydney December 1999 - January 2000

The Sydney Asian Gay Men's Survey is a cross-sectional survey of gay and homosexually active men of Asian background recruited through a range of gay community sites in Sydney. It provides a snapshot of sexual and HIV-related practices among gay and homosexually active men of Asian background