The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

Holt, Martin; Lea, Toby; Asselin, Jason; Hellard, Margaret; Prestage, Garrett; Wilson, David; Wit, John de; Stoové, Mark

doi:10.7448/ias.18.1.20526

Cited by 32 publications

(32 citation statements)

References 27 publications

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“…35,36 This suggests to us that the preventative benefits of treatment have been outweighed by other changes, such as increases in condomless sex and the disproportionate role of undiagnosed HIV in driving new infections. 37 In the arena of sexual practices, our results indicate that while the proportion of GBM with a high number of recent sexual partners has declined since 2000, condomless anal sex has become more common. It is unclear why partner numbers have declined.…”

Section: Discussionmentioning

confidence: 81%

“…24,41,42 In fact, the greater reliance on serosorting may have increased the exposure of HIV-negative men to undiagnosed HIV, which may explain why other positive changes (such as the increase in HIV treatment and undetectable viral load) have had limited effect. 12,37 Based on current trends, we expect CAI between casual partners to become more common over time and for HIV notifications to continue to rise if additional protective strategies are not deployed. Therefore, other than trying to sustain current levels of condom use, there is considerable focus in Australia on the introduction of PrEP.…”

Section: Discussionmentioning

confidence: 99%

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Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

et al. 2017

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Abstract. Background:In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission. Methods: The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia's primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000-15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. Results: Between 2000 and 2015, there were significant increases (P < 0.001) in annual HIV testing (56.1-64.8%), condomless sex with casual partners (26.8-38.8%) and the proportion of HIV-positive men on HIV treatment (72.5-88.4%) and with an undetectable viral load (73.7-94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. Conclusions: Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

et al. 2017

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“…This approach produces a prevalence estimate using data on HIV diagnoses from Australia’s National HIV Registry, adjusting for duplicate entries, deaths, and migration outside of Australia. For this estimate we will focus on HIV diagnoses where homosexual contact is identified as the route of transmission.Annual prevalence of undiagnosed HIV infection among gay and bisexual men: will be estimated using standard back-project models [16] and validated against a separate bio-behavioural survey conducted in 2013–2014 and to be repeated in 2017 [17]. …”

Section: Methodsmentioning

confidence: 99%

“…Annual prevalence of undiagnosed HIV infection among gay and bisexual men: will be estimated using standard back-project models [16] and validated against a separate bio-behavioural survey conducted in 2013–2014 and to be repeated in 2017 [17]. …”

Section: Methodsmentioning

confidence: 99%

A longitudinal cohort study of HIV ‘treatment as prevention’ in gay, bisexual and other men who have sex with men: the Treatment with Antiretrovirals and their Impact on Positive And Negative men (TAIPAN) study protocol

Callander¹,

Stoové

Carr

et al. 2016

BMC Infect Dis

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BackgroundAustralia has increased coverage of antiretroviral treatment (ART) over the past decade, reaching 73% uptake in 2014. While ART reduces AIDS-related deaths, accumulating evidence suggests that it could also bolster prevention efforts by reducing the risk of HIV transmission (‘treatment as prevention’). While promising, evidence of community-level impact of treatment as prevention on reducing HIV incidence among gay and bisexual men is limited. We describe a study protocol that aims to determine if scale up of testing and treatment for HIV leads to a reduction in community viraemia and, in turn, if this reduction is temporally associated with a reduction in HIV incidence among gay and bisexual men in Australia’s two most populous states.MethodsOver the period 2009 to 2017, we will establish two cohorts making use of clinical and laboratory data electronically extracted retrospectively and prospectively from 73 health services and laboratories in the states of New South Wales and Victoria. The ‘positive cohort’ will consist of approximately 13,000 gay and bisexual men (>90% of all people living with HIV). The ‘negative cohort’ will consist of at least 40,000 HIV-negative gay and bisexual men (approximately half of the total population). Within the negative cohort we will use standard repeat-testing methods to calculate annual HIV incidence. Community prevalence of viraemia will be defined as the proportion of men with a viral load ≥200RNA copies/mm3, which will combine viral load data from the positive cohort and viraemia estimates among those with an undiagnosed HIV infection. Using regression analyses and adjusting for behavioural and demographic factors associated with infection, we will assess the temporal association between the community prevalence of viraemia and the incidence of HIV infection. Further analyses will make use of these cohorts to assess incidence and predictors of treatment initiation, repeat HIV testing, and viral suppression.DiscussionThis study will provide important information on whether ‘treatment as prevention’ is associated with a reduction in HIV incidence at a community level among gay and bisexual men.

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“…19 Furthermore, men can have incorrect perceptions of the HIV-negative status of both themselves and their partners. 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.…”

Section: Introductionmentioning

confidence: 99%

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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The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

Cited by 32 publications

References 27 publications

Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

A longitudinal cohort study of HIV ‘treatment as prevention’ in gay, bisexual and other men who have sex with men: the Treatment with Antiretrovirals and their Impact on Positive And Negative men (TAIPAN) study protocol

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

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