Changes to the perception of HIV prevention strategies, risks, and norms during rapid PrEP uptake among gay and bisexual men in Australia

Men who have sex with men still comprise most new HIV cases in Australia. Condoms were the main HIV risk reduction strategy used for most of the HIV epidemic. Over the past decade, gay and bisexual men (GBM) have adopted a range of HIV risk reduction strategies, including PrEP. These changes have shifted HIV prevention norms in place for decades. In this thesis, I set out to understand how these changes affected how GBM negotiated sex and HIV risk, with a particular focus on GBM who struggle to use an effective HIV prevention method, despite the broader range available. A community-based, social public health approach was taken, with a focus on understanding the impact of PrEP practices and recommendations to improve health promotion. National survey data were analysed on changing attitudes to condoms among GBM. Cohort study data were used to identify the characteristics of GBM who did not consistently use HIV risk reduction strategies. Qualitative interviews were undertaken with GBM in Sydney to explore why some do not use a HIV risk reduction strategy and changing practices of HIV and PrEP disclosure. The survey data found consistently negative attitudes towards condoms among GBM and that it had become harder to discuss condom use with partners as PrEP use increased. Men who did not consistently use any HIV prevention strategy were younger, less educated, preferred receptive anal intercourse, and were less socially engaged with GBM. In qualitative analysis, the characteristics of encounters that featured little or no HIV risk reduction included: familiarity and trusting partners; pleasure and intoxication; expectations that partners were using PrEP or HIV treatment as prevention; and sometimes feelings of inevitability about acquiring HIV. In the context of increasing PrEP use, clear expectations about HIV and PrEP disclosure had not yet emerged, with some GBM only disclosing online and others not at all. The rapid uptake of PrEP has changed the way that GBM negotiate sex and HIV risk. As condoms have become harder to discuss with partners and no clear norms about PrEP disclosure have yet emerged, negotiating risk has become more complicated. GBM not using any HIV risk reduction strategy should be supported to adopt one compatible with situations in which they experience risk. This is important to increase community knowledge about effective HIV prevention strategies and support GBM to negotiate sex when there are no clear norms or expectations about disclosure

Partner abuse and its association with emotional distress: A study exploring LGBTI relationships

This study examines partner abuse in LBGTI relationships, with focus on the associations with emotional distress and protective factors. Two hundred and eighty-seven participants took part. Partner abuse (victimisation) comprised three factors; conflict orientated aggression; hostile ignorance and control of communication; and social control and possessiveness (including threats to possessions). Perpetration factors were similar. Significant differences across sexuality or gender were limited to the perpetration of abuse relating to suspicion and possessiveness, where men were more likely to report this than the other gender groups, and women were less likely to report this. Of those reporting abuse in their current relationship, over half reported experiencing abuse in a primary relationship previously, with 60 per cent reporting exposure to abuse as a child. Partner abuse in their current relationship predicted current levels of increased emotional distress, with reduced satisfaction with the current relationship having an indirect impact on this association. Resilience traits were not a predictor or mediator. The results demonstrate the similarity in abuse across LGB communities despite the diversity of genders, sexualities and experiences within these groups. The results are discussed with regards to directions for future research and implications for practic

Changes in social networks are associated with lesbian, bisexual and queer women quitting smoking: an analysis of Australian survey data

Introduction & Aims: Lesbian, bisexual and queer (LBQ) women in Australia and internationally are smoking at least twice the rate of women in the general population. An understanding of smoking behaviours in this population is essential in order to develop effective interventions. Our analysis aimed to investigate differences in smoking patterns and contexts of smoking between current smokers and recent quitters (<2 years to 1 month). Design & Methods: Data were collected through an online anonymous survey conducted in mid-2015. Participants were recruited online from a variety of social networking sites and community based mailing groups. Results: Overall 257 LBQ women completed the survey, 73% current smokers and 27% recent quitters; nearly all had smoked daily at some point in their lives. Multivariate analysis showed recent quitters were less likely to have some (aOR 0.19, 95% CI 0.05-0.71) or half/most/all (aOR 0.12, 95% CI 0.03-0.048) close friends who smoked compared to none, and were more likely to have a non-smoking (aOR 10.2, 95% CI 3.86-27.0) or no regular partner (aOR 4.01, 95% CI 1.47-10.9) than one who smoked. Non-Anglo-Australian women were also more likely to be recent quitters (aOR 2.45 (95% CI 1.10-5.42)) than Anglo-Australian women. Discussion & Conclusions: Understanding the social significance of partners and friends in LBQ women’s smoking and cessation efforts will be important for developing meaningful, effective and targeted interventions to address the persistent high rates of smoking in this population

Lesbian, Bisexual and Queer (LBQ) Women’s Tobacco Reduction Project Community Report Online Survey Findings

Cancer Institute NSW, ACON Health, Sydney School of Public Healt

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

COVID-19 Vaccination Uptake and Hesitancy in a National Sample of Australian Gay and Bisexual Men

Minority groups may face additional barriers to vaccination. In April–June 2021, we assessed the level of COVID-19 vaccination and willingness to be vaccinated in a national, online survey of 1280 gay and bisexual men in Australia. Over a quarter of the sample (28.0%) had been partially or fully vaccinated, and 80.0% of the unvaccinated were willing to be vaccinated. Vaccination was independently associated with older age, being university educated, and HIV status (with HIV-positive participants being more likely and untested participants less likely to be vaccinated). Willingness to be vaccinated was independently associated with living in a capital city and being university educated. Those who had lost income or their job due to COVID-19 were less willing to be vaccinated. Our results suggest encouraging COVID-19 vaccination among those with lower levels of health literacy and supporting those who have experienced financial stress because of the pandemic

Explicit Relationship Agreements and HIV Pre-exposure Prophylaxis Use by Gay and Bisexual Men in Relationships

Relationship agreements are important for HIV prevention among gay and bisexual men (GBM) in relationships, with research earlier in the HIV epidemic often finding that agreements specified monogamy or condom use with casual partners. There is evidence that HIV pre-exposure prophylaxis (PrEP) has shifted sexual practices among some men in relationships, such as allowing condomless sex with casual partners, but there has been little attention paid to relationship agreements among GBM who use PrEP. In this paper, we analyzed national, Australian, cross-sectional data from an online survey completed by non-HIV-positive GBM in 2021 (N = 1,185). Using logistic regression, we identified demographic characteristics, sexual practices and the types of relationship agreement that were associated with PrEP use among GBM in relationships. Using Pearson’s chi-squared tests, we explored whether PrEP users in relationships reported similar sexual practices to PrEP users not in relationships. PrEP use among GBM in relationships was independently associated with older age, identifying as gay, being in a non-monogamous relationship, having a spoken (explicit) relationship agreement, having a primary HIV-negative partner taking PrEP or a primary partner living with HIV, reporting recent condomless casual sex, reporting an STI diagnosis in the past year, and knowing at least one other PrEP user. We found that PrEP users in relationships had similar sexual practices to PrEP users not in relationships. GBM in relationships who have casual sex and who meet PrEP suitability criteria may be good candidates for PrEP. Our findings suggest that explicit relationship agreements remain important for HIV prevention, and they support PrEP use among GBM in relationships

Changing Attitudes Towards Condoms Among Australian Gay and Bisexual Men in the PrEP Era: An Analysis of Repeated National Online Surveys 2011-2019

Condoms have been the primary form of HIV prevention for gay and bisexual men (GBM) for most of the HIV epidemic. The introduction of biomedical HIV prevention may have changed attitudes towards condoms. Data from repeated national online surveys of GBM in Australia were used to examine how attitudes towards condoms and confidence discussing condoms with partners changed in the period 2011-2019. The proportion of all participants who reported a positive experience in using condoms remained low and unchanged (9.6% in 2011 to 6.0% in 2019). Confidence in discussing condoms with partners decreased over time (from 72.2% in 2011 to 56.6% in 2019). Confidence in discussing condoms was associated with concern about sexually transmitted infections, and more consistent condom use. Sustaining confidence in using condoms may be more challenging as biomedical prevention methods become more commonly used