Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998–2020

Abstract

Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.

Trends in Testing and Self-Reported Diagnoses of Sexually Transmitted Infections in Gay and Bisexual Men in Australia, 2017-2021: Analysis of National Behavioural Surveillance Surveys

“…Those who were more socially engaged with gay men and who lived in areas with high concentrations of gay men were more likely to test frequently or receive an STI diagnosis. These results are consistent with previous evidence showing that connection to gay community has been linked to protective sexual health behaviors, such as HIV testing and PrEP use, 17,31 as well as behaviors that increase STI risk such as having a higher number of sexual partners and condomless anal intercourse 24,32 . Our results showed that those who are most sexually active are indeed more likely to engage with STI testing.…”

“…Sexually Transmitted Diseases • Volume 50, Number 12, December 2023 use, 17,31 as well as behaviors that increase STI risk such as having a higher number of sexual partners and condomless anal intercourse. 24,32 Our results showed that those who are most sexually active are indeed more likely to engage with STI testing. Our results demonstrated that substantial proportion GBM are not testing at our lower threshold of ≥3 tests per year compared with the quarterly testing guidelines.…”

“…Participants were dichotomized into groups based on whether they were born in Australia or not, had a university degree or not, and were in full-time employment or not. Gay social engagement was measured by a 2-item scale, with scores ranging from 0 to 7 based on their number of gay male friends and free time spent with those friends 24 . The proportion of gay residents living in the participants' postcodes was estimated using an established method 25 .…”

“…Gay social engagement was measured by a 2-item scale, with scores ranging from 0 to 7 based on their number of gay male friends and free time spent with those friends. 24 The proportion of gay residents living in the participants' postcodes was estimated using an established method. 25 Postcodes were categorized as "<5%," "5-< 10%," and "≥10%" gay male residents.…”

The relevance of communal altruism for sexual minority men in contemporary contexts

“…This is also supported by work from Oda et al (2011), showing that social connection (via social support) increases prosocial behavior. Thus, although it is unclear how community identity may relate directly to communal sexual altruism among GBM, given the existing work showing the importance of social connection for the activation of motivations for communal altruism (e.g., Brown & Brown, 2006) and for engagement in some HIV prevention behaviors (Chan et al, 2022), this may be a particularly important factor to consider.…”