Gay Men’s Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data

MacGibbon, James; Broady, Timothy; Drysdale, Kerryn; Bavinton, Benjamin R.; Lee, Evelyn; Mao, Limin; Prestage, Garrett; Holt, Martin

doi:10.1007/s10461-019-02737-9

Cited by 13 publications

(16 citation statements)

References 35 publications

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“…Prior to PrEP, research has generally found that most Australian GBM in relationships either had agreements that prohibited casual sex or specified that condoms should be used with casual partners (Crawford et al, 2001 ; Kippax et al, 1997 ). After PrEP became more commonly used, national, Australian survey data showed that GBM in relationships who used PrEP were much more likely than non-PrEP-users to have condomless sex both within and outside the relationship, and to have agreements that permitted condomless sex with casual partners (MacGibbon et al, 2020 ). However, there was considerable variation in the types of agreement and sexual practices used by GBM after PrEP roll-out in Australia, with a notable minority either having no agreement with their relationship partner or appearing to have casual sex that was not permitted by their agreement (MacGibbon et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Relationship agreements regarding CAI have been expanding beyond just between main partners to include CAI with casual partners, especially among PrEP users. 28 A limitation of our findings is that data on PrEP use, viral suppression, and perceptions of partners' HIV status were self-reported. In addition, social desirability of reporting higher personal responsibility and lower risk behavior may have affected responses related to engaging in CAI.…”

Section: Discussionmentioning

confidence: 92%

HIV Prevention Responsibility Beliefs Among Men Who Have Sex With Men in the PrEP Era

Truong

Fatch

McFarland

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Beliefs regarding responsibility for preventing HIV transmission may differ between individuals and their sexual partners. We assessed HIV prevention responsibility beliefs among men who have sex with men (MSM) participating in the 2017 National HIV Behavioral Surveillance survey.Methods: MSM were recruited using time-location sampling at clubs, bars, and street locations in San Francisco. HIV prevention responsibility beliefs were assessed on a four-point scale (1 = strongly disagree to 4 = strongly agree). Associations were assessed using generalizing estimating equations to adjust for behaviors within multiple partnerships.Results: A total of 316 HIV-negative men and 76 HIV-positive men reported on 1336 partnerships. HIV-negative compared with HIV-positive men had higher endorsement of mutual responsibility (mean 3.7 vs. 3.5; P , 0.01). Both groups had similar levels of endorsing responsibility on the HIV-negative or HIV-positive partner. HIV-positive men endorsing equal responsibility were more likely to know their partner's HIV status (P , 0.01) and less likely to have serodiscordant condomless anal intercourse (CAI) (P , 0.01) than men who did not endorse equal responsibility. HIV-negative men in partnerships with pre-exposure prophylaxis (PrEP) use were more likely to know their partner's HIV status (P = 0.02) and have serodiscordant CAI (P = 0.04) than men not in partnerships with PrEP use.Conclusions: HIV-negative and HIV-positive men accept responsibility for preventing HIV. The finding that HIV-negative men in partnerships with PrEP use who engage in serodiscordant CAI is concerning because they are still at risk for other sexually transmitted infections, which are presently at elevated levels in San Francisco and other US cities.

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“…A previous scoping review found that having a sexual agreement with partners (beyond negotiated safety) was associated with engaging in condomless anal sex within the relationship and outside the relationship in several studies [ 19 ]. Similarly, Findings from repeated cross-sectional surveys in Australia from 2013 to 2018 found that PrEP use was associated with agreements between partners that allow condomless sex with casual partners, with almost 40% of PrEP users in relationships having such agreements [ 20 ]. While participants in our study who were on PrEP described negotiated safety within their partnerships, further research is required to understand whether there is an increase in other types of sexual agreements which allow condomless anal sex in this population.…”

Section: Discussionmentioning

confidence: 99%

Newly arrived Asian-born gay men in Australia: exploring men’s HIV knowledge, attitudes, prevention strategies and facilitators toward safer sexual practices

et al. 2022

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Background Asian-born gay, bisexual and other men who have sex with men (gbMSM) newly arrived in Australia are more than four times as likely than their Australian-born counterparts to be diagnosed with incident HIV. Our aim was to explore experiences of Asian-born gbMSM newly arrived in Australia and attending a sexual health centre with regards to their knowledge of and preference for HIV prevention strategies. Results Twenty-four gbMSM aged 20–30 years attending Melbourne Sexual Health Centre who were born in Asia and arrived in Australia in the preceding four years, participated in semi-structured face-to-face interviews from 8th May 2019 and 23rd December 2019. Men were excluded if they were living with HIV. Interviews were recorded, transcribed verbatim and analysed thematically. Men reported little knowledge of HIV prevention strategies outside of condom use prior to coming to Australia. Although participants reported basic knowledge of HIV transmission and treatment, exposure to sexual identity and HIV-related stigma in their countries of birth meant they imagined a HIV diagnosis would be devastating. Most relied on condoms to stay HIV negative however their consistency of use varied. Seven men were on pre-exposure prophylaxis (PrEP); all but one started PrEP after coming to Australia. Many indicated interest in PrEP but described it as too expensive given they do not have access to government-subsidized healthcare. Sexual health counselling and connections with LGBTQI community groups appeared to facilitate PrEP and consistent condom use. Conclusions Asian-born gbMSM newly-arrived to Australia may have limited knowledge of HIV prevention strategies aside from condom use. Increased connections with sexual health services and LGBTQI communities may facilitate more effective HIV prevention strategies.

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Gay Men’s Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data

Cited by 13 publications

References 35 publications

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

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

HIV Prevention Responsibility Beliefs Among Men Who Have Sex With Men in the PrEP Era

Newly arrived Asian-born gay men in Australia: exploring men’s HIV knowledge, attitudes, prevention strategies and facilitators toward safer sexual practices

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