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

The longer-term effects of access to HIV self-tests on HIV testing frequency in high-risk gay and bisexual men: follow-up data from a randomised controlled trial

Background: A wait-list randomised controlled trial in Australia (FORTH) in high-risk gay and bisexual men (GBM) showed access to free HIV self-tests (HIVSTs) doubled the frequency of HIV testing in year 1 to reach guideline recommended levels of 4 tests per year, compared to two tests per year in the standard-care arm (facility-based testing). In year 2, men in both arms had access to HIVSTs. We assessed if the effect was maintained for a further 12 months. Methods: Participants included GBM reporting condomless anal intercourse or > 5 male partners in the past 3 months. We included men who had completed at least one survey in both year 1 and 2 and calculated the mean tests per person, based on the validated self-report and clinic records. We used Poisson regression and random effects Poisson regression models to compare the overall testing frequency by study arm, year and testing modality (HIVST/facility-based test). Findings: Overall, 362 men completed at least one survey in year 1 and 343 in year 2. Among men in the intervention arm (access to HIVSTs in both years), the mean number of HIV tests in year 2 (3⋅7 overall, 2⋅3 facility-based tests, 1⋅4 HIVSTs) was lower compared to year 1 (4⋅1 overall, 1⋅7 facility-based tests, 2⋅4 HIVSTs) (RR:0⋅84, 95% CI:0⋅75-0⋅95, p=0⋅002), but higher than the standard-care arm in year 1 (2⋅0 overall, RR:1⋅71, 95% CI:1⋅48-1.97, p<0⋅001). Findings were not different when stratified by sociodemographic characteristics or recent high risk sexual history. Interpretation: In year 2, fewer HIVSTs were used on average compared to year 1, but access to free HIVSTs enabled more men to maintain higher HIV testing frequency, compared with facility-based testing only. HIV self-testing should be a key component of HIV testing and prevention strategies. Funding:: This work was supported by grant 568971 from the National Health and Medical Research Council of Australia

Following Lives Undergoing Change (Flux) study: Implementation and baseline prevalence of drug use in an online cohort study of gay and bisexual men in Australia

Background: Drug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal methamphetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM). Objective: This paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this sample. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen. Methods: Men living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol. Results: Between September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs. Conclusion: Ease of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM

Increase in Depression and Anxiety Among Australian Gay and Bisexual Men During COVID-19 Restrictions: Findings from a Prospective Online Cohort Study

We examined depression and anxiety prior to and during COVID-19 restrictions in Australian gay and bisexual men (GBM). In an online cohort, a COVID-19-focused survey was conducted in April 2020. During 2019 and in April 2020, 664 GBM completed the Patient Health Questionnaire (PHQ-9, measuring depression) and Generalized Anxiety Disorder Assessment (GAD-7, measuring anxiety). Increased depression and anxiety were defined as a ≥ 5 point increase on the respective scales. Mean PHQ-9 and GAD-7 scores increased between 2019 and 2020 (PHQ-9: from 5.11 in 2019 to 6.55 in 2020; GAD-7: from 3.80 in 2019 to 4.95 in 2020). The proportion of participants with moderate-severe depression (PHQ-9 ≥ 10) increased from 18.8% (n = 125) to 25.5% (n = 169), while the proportion of participants with moderate-severe anxiety (GAD-7 ≥ 10) increased from 12.7% (n = 84) to 17.3% (n = 115). Almost one-quarter of participants (n = 158, 23.8%) had increased depression; in these men, mean PHQ-9 increased from 2.49 in 2019 to 11.65 in 2020 (p < 0.001). One-in-five (20.6%) participants (n = 137) had increased anxiety; among these men, mean GAD-7 increased from 2.05 in 2019 to 10.22 in 2020 (p < 0.001). Increases were associated with concerns about job security, reduction in social and sexual connections and opportunities, and being personally concerned about COVID-19 itself. COVID-19 appeared to have a sudden and pronounced impact on depression and anxiety in Australian GBM, with a significant minority showing sharp increases. Ongoing monitoring is required to determine longer-term impacts and GBM need access to appropriate and sensitive supports both during and after the COVID-19 pandemic

Municipal enterprises. by Colin Taylor and Roger Batrouney

The State Bank TriCo problems were not evident when the provisions relating to local government involvement in enterprises were enacted. It will be interesting to see if any backlash develops to such initiatives in the wake of the problems and perceptions in Victoria concerning public forays

Fear appeals and treatment side-effects: An effective combination for HIV prevention?

Objective: To examine the barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia.Methods: In-depth, semi-structured interviews were conducted between February and September 2003 with 20 Aboriginal people who were HIV-positive; almost half the total number of Aboriginal people known to be living with HIV in Western Australia at that time.Results: Despite having access to treatments in both urban and rural areas, only 11 of the 20 participants were on antiretroviral treatment at the time of interview. Four of the women had been prescribed treatment during pregnancy only. The main barriers to treatment uptake were fear of disclosure and discrimination, heavy alcohol consumption and poverty. The incentives were pregnancy and access to services whose approach can be described as broad-based and holistic, i.e. supporting people in the context of their everyday lives by providing psychosocial and welfare support as well as healthcare