The Meaning of ‘Regular Partner’ in HIV Research Among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey

Bavinton, Benjamin R.; Duncan, Duane; Grierson, Jeffrey; Zablotska, Iryna; Down, Ian; Grulich, Andrew E.; Prestage, Garrett

doi:10.1007/s10461-016-1354-5

Cited by 30 publications

(37 citation statements)

References 11 publications

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“…12,32 Briefly, the present study was a cross-sectional online survey of Australian GBM conducted in December 2013-January 2014. Participants were recruited via gay community websites, online media, Facebook, mobile telephone applications and gay sexual networking websites.…”

Section: Methods Proceduresmentioning

confidence: 99%

“…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. 12 However, CLAI in some types of regular partnerships has been found to be largely low risk, particularly among HIV-negative men with HIV-negative partners and among HIV serodiscordant couples, in the era of widespread, effective HIV treatments. 13,14 Modelling from the US and Peru indicates that if CLAI with casual partners was replaced with CLAI with 'main' partners, HIV prevalence could be reduced, reinforcing the suggestion that risk may be lower with regular compared with casual partners.…”

Section: Introductionmentioning

confidence: 99%

“…1 Much HIV research among GBM distinguishes between 'regular' and 'casual' sexual partners, but does not differentiate between types of regular partners. 12 Regular sexual partnerships not considered to be 'relationships' and primarily organised around sex (i.e. 'fuckbuddies') are common among GBM.…”

Section: Introductionmentioning

confidence: 99%

“…'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.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, primarily sexual regular partnerships have largely been ignored in research and HIV prevention. 12 The specific aims of the present study were to: (1) determine the proportion of partnerships of various seroconcordances; (2) determine the prevalence of CLAI among them; (3) determine the factors differentiating romantic or committed relationships from primarily sexual partnerships that reported CLAI; (4) estimate the amount of CLAI that may present high risk for HIV transmission; and (5) determine the factors associated with CLAI that may present HIV transmission risk.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Abstract. Background: Regular sexual partnerships among gay and bisexual men (GBM) who practice condomless anal intercourse (CLAI) have not been well characterised in terms of partnership type, HIV seroconcordance and risk of HIV transmission. Primarily sexual regular partnerships, although commonly reported by gay men, have largely been ignored in research and HIV prevention. Among regular partners reporting CLAI with each other, we determined factors differentiating romantic or committed relationships from partnerships organised primarily around sex ('fuckbuddies') and estimated the proportion of CLAI presenting risk for HIV transmission. Methods: An online, cross-sectional survey of Australian GBM was conducted. Univariate and multivariate generalised estimating equations were used to determine statistical associations. Results: Men reported on 2250 regular sexual partnerships. Over half the partnerships were romantic or committed relationships. Over half the partnerships were HIV-negative seroconcordant (54.9%), 3.1% were HIV-positive seroconcordant, 5.2% were serodiscordant and 36.8% were of unknown seroconcordance. Potential risks presented by CLAI were sometimes mitigated by protective factors, such as having a clear spoken agreement about sex with outside partners, having fewer outside partners, openly discussing HIV risk and having an agreement to reduce risk from outside partners. These protective factors were more often found in romantic or committed relationships than among primarily sexual partnerships, and were less often found in partnerships of unknown seroconcordance. Conclusion: CLAI is more common among regular sexual partnerships considered to be of a romantic, committed nature. However, factors associated with such romantic or committed partnerships can also protect against HIV transmission risk. Unknown seroconcordance, particularly lack of communication about HIV status among primarily sexual partnerships, is a key risk factor that needs to be addressed by HIV education.Additional keywords: HIV prevention, men who have sex with men, relationships.

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Section: Methods Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries

et al. 2019

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Introduction There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. Methods Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV‐positive partners had viral load (VL) tested; HIV‐negative partners reported sexual behaviour and perceptions of their HIV‐positive partner's VL results. Within‐couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom‐protected, biomedically protected (undetectable VL and/or pre‐exposure prophylaxis [PrEP]), or not protected by either (HIV‐negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). Results A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three‐quarters of HIV‐positive partners were consistently virally suppressed (<200 copies/mL) during follow‐up, and HIV‐negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One‐third of HIV‐negative partners used daily PrEP during follow‐up. Over follow‐up, 73.8% of couples had CLAI. HIV‐negative partners reported 31,532 acts of anal intercourse with their HIV‐positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom‐protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two‐thirds (n = 983) were when the HIV‐negative partner was insertive (strategic positioning). Of the 490 acts when the HIV‐negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. Conclusions Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.

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

Down¹,

Ellard

Bavinton³

et al. 2017

AIDS Behav

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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.

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The Meaning of ‘Regular Partner’ in HIV Research Among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey

Cited by 30 publications

References 11 publications

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

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

Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries

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

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