In Australia, Most HIV Infections Among Gay and Bisexual Men are Attributable to Sex with ‘New’ Partners

Abstract

It has been estimated that the majority of global HIV infections among gay and bisexual men (GBM) can be attributed to sex within a committed relationship. In Australia, however, negotiated safety, whereby HIV-negative regular partners agree to discard condoms with each other but commit to consistent condom use with other partners, has been promoted as a key component of the HIV prevention response. We asked GBM recently diagnosed with HIV to describe their relationship to the person they believed to be the source of their infection ('source person'). The majority (66.1%) ascribed their infection to a casual partner. A further 23.3% ascribed their infection to a non-committed and non-romantic partner (or 'fuckbuddy'). Only 10.6% believed they had acquired their HIV from a 'boyfriend' in the context of a committed romantic relationship, and 51.7% of these occurred within the first 3 months following their first sexual contact. Most men (61.5%) believed they had acquired their HIV infection on the first occasion they had sex with the source person. In the Australian context, negotiated safety appears to have minimised infections between regular partners. However, many HIV infections between regular partners may not be in the context of a romantic committed relationship, and yet this distinction between types of regular partners has been all but ignored. Furthermore, in this sample, most infections occurred on the occasion of first meeting, suggesting that the most useful indicators of risk may be the characteristics, contexts, and lengths of sexual partnerships and how sex is negotiated, rather than how GBM categorize their partner. Findings suggest more new HIV infections occur in new partnerships, than in established relationships.

How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men

“…3 Approximately one-third of infections among newly diagnosed men in Australia are estimated to be from regular partners, [4][5][6] whereas modelling from the US estimates that 68% of infections in GBM are from 'main' partners. 7 Intimacy and familiarity with partners have been associated with increased CLAI among GBM, [8][9][10][11] and HIV prevention and research have described ongoing sexual relationships as potentially high risk for HIV transmission.…”

“…'fuckbuddies') are common among GBM. 12,15,16 In Australia, among newly HIV-diagnosed GBM who ascribed their HIV infection to a regular partner, over two-thirds considered them to be 'fuckbuddies' rather than 'boyfriends' 6,17 and, among these newly diagnosed GBM, the majority of transmissions from regular partners were believed to have occurred within the first 3 months of meeting. Similarly, research on serodiscordant GBM regular partnerships, where one partner is HIV-positive and the other is HIVnegative, demonstrated that the HIV transmission rate was approximately 6 per 100 person-years in the first year, but decreased to approximately 1 per 100 person-years thereafter.…”

“…In Australia, 9.1% of GBM who believed they were HIV negative were actually undiagnosed HIV positive, 20 whereas in two separate studies, 10% and 20% of new diagnoses among GBM were ascribed to a partner believed to be HIV-negative. 21,22 It is estimated that 31% of new infections in Australia are from people whose HIV infection is undiagnosed. 23 Within HIV-negative seroconcordant relationships (i.e.…”

“…26 This may explain, in part, the lower proportion of infections ascribed to romantic, committed relationships compared with elsewhere. 6 However, in Australia, the proportion of HIVnegative seroconcordant relationships with negotiated safety agreements has declined significantly over the past decade. 26 Serodiscordant regular relationships have usually been considered a context of high transmission risk.…”

“…14,29 In Australia, only 6.4% of newly diagnosed GBM ascribed their infection to a known HIV-positive regular partner. 22 In the era of 'treatment as prevention', GBM in serodiscordant partnerships are increasingly likely to rely on undetectable viral load to prevent transmission. 27,30,31 However, viral load-based agreements do not appear to have been widely promoted in HIV education.…”