Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys
Martin Holt A E , Toby Lea A , Limin Mao A , Iryna Zablotska B , Evelyn Lee A , Peter Hull A , John B. F. de Wit A C and Garrett Prestage B D
+ Author Affiliations
- Author Affiliations
A The University of New South Wales, Centre for Social Research in Health, Sydney, NSW 2052, Australia.
B The University of New South Wales, The Kirby Institute, Sydney, NSW 2052, Australia.
C Utrecht University, Department of Interdisciplinary Social Science, 3584 CS Utrecht, Netherlands.
D La Trobe University, Australian Research Centre in Sex Health and Society, Melbourne, Vic. 3000, Australia.
E Corresponding author. Email: m.holt@unsw.edu.au
Sexual Health 14(1) 72-79 https://doi.org/10.1071/SH16072
Submitted: 30 April 2016 Accepted: 18 July 2016 Published: 29 August 2016
Journal Compilation © CSIRO Publishing 2017 Open Access CC BY-NC-ND
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.
References
[1] UNAIDS/WHO. Guidelines for second generation HIV surveillance. Geneva: UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance; 2000.[2] Rehle T, Lazzari S, Dallabetta G, Asamoah-Odei E. Second-generation HIV surveillance: better data for decision-making. Bull World Health Organ 2004; 82 121–7.
| 15042234PubMed |
[3] Saxton P, Dickson N, Hughes A. Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends. AIDS Behav 2013; 17 3133–44.
| Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends.Crossref | GoogleScholarGoogle Scholar | 23605157PubMed |
[4] Paquette D, De Wit J. Sampling methods used in developed countries for behavioural surveillance among men who have sex with men. AIDS Behav 2010; 14 1252–64.
| Sampling methods used in developed countries for behavioural surveillance among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 20614177PubMed |
[5] Zablotska I, Holt M, Prestage G. Changes in gay men’s participation in gay community life: implications for HIV surveillance and research. AIDS Behav 2012; 16 669–75.
| Changes in gay men’s participation in gay community life: implications for HIV surveillance and research.Crossref | GoogleScholarGoogle Scholar | 21424273PubMed |
[6] Zablotska I, Kippax S, Grulich A, Holt M, Prestage G. Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections. Sex Health 2011; 8 272–9.
| Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections.Crossref | GoogleScholarGoogle Scholar | 21851766PubMed |
[7] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365 493–505.
| Prevention of HIV-1 infection with early antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXhtVars7jF&md5=5e8cfcb6a2f8c0e2d30e37ecdba2e326CAS | 21767103PubMed |
[8] Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 2587–99.
| Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXit1ansg%3D%3D&md5=6e22600cda8924441c0d2faa55711ff6CAS | 21091279PubMed |
[9] Mansergh G, Koblin B, Sullivan P. Challenges for HIV pre-exposure prophylaxis among men who have sex with men in the United States. PLoS Med 2012; 9 e1001286
| 22927797PubMed |
[10] Jin F, Prestage GP, Mao L, Poynten IM, Templeton DJ, et al “Any condomless anal intercourse” is no longer an accurate measure of HIV sexual risk behavior in gay and other men who have sex with men. Front Immunol 2015; 6 86
| “Any condomless anal intercourse” is no longer an accurate measure of HIV sexual risk behavior in gay and other men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 25774158PubMed |
[11] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2015. Sydney: The Kirby Institute, UNSW Australia; 2015.
[12] Holt M, Lea T, Mao L, Zablotska I, Prestage G, de Wit J. HIV prevention by Australian gay and bisexual men with casual partners: the emergence of undetectable viral load as one of a range of risk reduction strategies. J Acquir Immune Defic Syndr 2015; 70 545–8.
| HIV prevention by Australian gay and bisexual men with casual partners: the emergence of undetectable viral load as one of a range of risk reduction strategies.Crossref | GoogleScholarGoogle Scholar | 26258572PubMed |
[13] Zablotska I, Prestage GP, Middleton M, Wilson D, Grulich AE. Contemporary trends in HIV diagnoses in Australia can be predicted by trends in unprotected anal intercourse among gay men. AIDS 2010; 24 1955–8.
| Contemporary trends in HIV diagnoses in Australia can be predicted by trends in unprotected anal intercourse among gay men.Crossref | GoogleScholarGoogle Scholar | 20543653PubMed |
[14] Gianacas C, Down I, Ellard J, Kidd P, Brown G, Triffitt K, et al. Experiences of HIV: the Seroconversion Study final report 2007–2015. Sydney: The Kirby Institute, UNSW Australia; 2016.
[15] Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS 2009; 23 1153–62.
| Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities.Crossref | GoogleScholarGoogle Scholar | 19417579PubMed |
[16] Elford J. Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy. Curr Opin Infect Dis 2006; 19 26–32.
| Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 16374214PubMed |
[17] Sullivan PS, Hamouda O, Delpech V, Geduld JE, Prejean J, Semaille C, et al Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Ann Epidemiol 2009; 19 423–31.
| Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005.Crossref | GoogleScholarGoogle Scholar | 19460672PubMed |
[18] Holt M, Lee E, Prestage G, Zablotska I, De Wit J, Mao L. The converging and diverging characteristics of HIV-positive and HIV-negative gay men in the Australian Gay Community Periodic Surveys, 2000–2009. AIDS Care 2013; 25 28–37.
| The converging and diverging characteristics of HIV-positive and HIV-negative gay men in the Australian Gay Community Periodic Surveys, 2000–2009.Crossref | GoogleScholarGoogle Scholar | 22639958PubMed |
[19] De Wit J, Mao L, Adam P, Treloar C, editors. HIV/AIDS, hepatitis and sexually transmissible infections in Australia: annual report of trends in behaviour 2015. Sydney: Centre for Social Research in Health, UNSW Australia; 2015.
[20] National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2008. Sydney: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales; 2008.
[21] Commonwealth of Australia. Seventh National HIV Strategy 2014–2017. Canberra: Australian Government Department of Health; 2014.
[22] NSW Ministry of Health. NSW HIV strategy 2016–2020. Sydney: NSW Health; 2015.
[23] Mao L, Kippax S, Holt M, Prestage G, Zablotska I, De Wit J. Rates of condom and non-condom based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction? Sex Transm Infect 2011; 87 489–93.
| Rates of condom and non-condom based anal intercourse practices among homosexually active men in Australia: deliberate HIV risk reduction?Crossref | GoogleScholarGoogle Scholar | 21764890PubMed |
[24] Jin F, Crawford J, Prestage GP, Zablotska I, Imrie JC, Kippax SC, et al Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS 2009; 23 243–52.
| Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men.Crossref | GoogleScholarGoogle Scholar | 19098494PubMed |
[25] Grulich AE, de Visser RO, Badcock PB, Smith AMA, Heywood W, Richters J, et al Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships. Sex Health 2014; 11 439–50.
| Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships.Crossref | GoogleScholarGoogle Scholar | 25376997PubMed |
[26] Holt M, Hull P, Lea T, Guy R, Bourne C, Prestage G, et al Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003–2012. Sex Transm Infect 2014; 90 208–15.
| Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003–2012.Crossref | GoogleScholarGoogle Scholar | 24234070PubMed |
[27] de Wit JBF, Adam PCG. To test or not to test: psychosocial barriers to HIV testing in high-income countries. HIV Med 2008; 9 20–2.
| To test or not to test: psychosocial barriers to HIV testing in high-income countries.Crossref | GoogleScholarGoogle Scholar |
[28] Prestage G, Brown G, Keen P. Barriers to HIV testing among Australian gay men. Sex Health 2012; 9 453–8.
| Barriers to HIV testing among Australian gay men.Crossref | GoogleScholarGoogle Scholar | 23380195PubMed |
[29] Adam PCG, Wit JBF, Bourne CP, Knox D, Purchas J. Promoting regular testing: an examination of HIV and STI testing routines and associated socio-demographic, behavioral and social-cognitive factors among men who have sex with men in New South Wales, Australia. AIDS Behav 2014; 18 921–32.
| Promoting regular testing: an examination of HIV and STI testing routines and associated socio-demographic, behavioral and social-cognitive factors among men who have sex with men in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar |
[30] Wilkinson AL, El-Hayek C, Spelman T, Fairley C, Leslie D, McBryde E, et al “Seek, test, treat” lessons from Australia: a study of HIV testing patterns from a cohort of men who have sex with men. J Acquir Immune Defic Syndr 2015; 69 460–5.
| “Seek, test, treat” lessons from Australia: a study of HIV testing patterns from a cohort of men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 25835608PubMed |
[31] UNAIDS. Ten targets: 2011 United Nations Political Declaration on HIV and AIDS, Global progress and lessons learned, 2011–2015. Geneva: UNAIDS; 2015.
[32] De La Mata NL, Mao L, De Wit J, Smith D, Holt M, Prestage G, et al Estimating antiretroviral treatment coverage rates and viral suppression rates for homosexual men in Australia. Sex Health 2015; 12 453–7.
| Estimating antiretroviral treatment coverage rates and viral suppression rates for homosexual men in Australia.Crossref | GoogleScholarGoogle Scholar | 26166247PubMed |
[33] Mao L, Adam PCG, Kippax S, Crooks L, Post JJ, Kidd MR, et al Evolving views and practices of antiretroviral treatment prescribers in Australia. Med J Aust 2015; 202 258–60.
| Evolving views and practices of antiretroviral treatment prescribers in Australia.Crossref | GoogleScholarGoogle Scholar | 25758697PubMed |
[34] Holt M, Lea T, Schmidt HM, Murphy D, Rosengarten M, Crawford D, et al Increasing belief in the effectiveness of HIV treatment as prevention: results of repeated, national surveys of Australian gay and bisexual men, 2013–15. AIDS Behav 2016; 20 1564–71.
| Increasing belief in the effectiveness of HIV treatment as prevention: results of repeated, national surveys of Australian gay and bisexual men, 2013–15.Crossref | GoogleScholarGoogle Scholar | 26803613PubMed |
[35] Wilson DP. HIV treatment as prevention: natural experiments highlight limits of antiretroviral treatment as HIV prevention. PLoS Med 2012; 9 e1001231
| HIV treatment as prevention: natural experiments highlight limits of antiretroviral treatment as HIV prevention.Crossref | GoogleScholarGoogle Scholar | 22807656PubMed |
[36] de Wit JBF, Adam PCG. Can treatment-based HIV prevention curb the epidemic among gay and other men who have sex with men? A narrative synthesis of increasing evidence for moderating and countervailing effects. Sex Health 2014; 11 137–45.
[37] Holt M, Lea T, Asselin J, Hellard M, Prestage G, Wilson D, et al The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community-based, bio-behavioural survey. J Int AIDS Soc 2015; 18 20526
| The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community-based, bio-behavioural survey.Crossref | GoogleScholarGoogle Scholar | 26563846PubMed |
[38] Hull P, Mao L, De Wit J, Prestage G, Zablotska I, Holt M. The use of mobile phone apps to meet sex partners by Australian gay and bisexual men: an analysis of sex-seeking repertoires and risks for HIV and STIs using behavioural surveillance data. Sex Transm Infect 2016; in press
| The use of mobile phone apps to meet sex partners by Australian gay and bisexual men: an analysis of sex-seeking repertoires and risks for HIV and STIs using behavioural surveillance data.Crossref | GoogleScholarGoogle Scholar | 27095378PubMed |
[39] Prestage G, Down IA, Bradley J, McCann PD, Brown G, Jin F, et al Is optimism enough? Gay men’s beliefs about HIV and their perspectives on risk and pleasure. Sex Transm Dis 2012; 39 167–72.
| Is optimism enough? Gay men’s beliefs about HIV and their perspectives on risk and pleasure.Crossref | GoogleScholarGoogle Scholar | 22337101PubMed |
[40] Mao L, Crawford JM, Hospers HJ, Prestage GP, Grulich AE, Kaldor JM, et al “Serosorting” in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS 2006; 20 1204–6.
| “Serosorting” in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 16691075PubMed |
[41] Zablotska I, Imrie J, Prestage G, Crawford J, Rawstorne P, Grulich A, et al Gay men’s current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing? AIDS Care 2009; 21 501–10.
| Gay men’s current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing?Crossref | GoogleScholarGoogle Scholar | 19266409PubMed |
[42] Golden MR, Stekler J, Hughes JP, Wood RW. HIV serosorting in men who have sex with men: is it safe? J Acquir Immune Defic Syndr 2008; 49 212–8.
| HIV serosorting in men who have sex with men: is it safe?Crossref | GoogleScholarGoogle Scholar | 18769346PubMed |
[43] Lea T, Murphy D, Rosengarten M, Kippax S, de Wit J, Schmidt HM, et al. Gay men’s attitudes to biomedical HIV prevention: Key findings from the PrEPARE Project 2015. Sydney: Centre for Social Research in Health, UNSW Australia; 2015.
[44] NSW Ministry of Health. NSW leading the way in fight against HIV [press release]. Sydney: NSW Ministry of Health, 1 December 2015.
[45] State Government of Victoria. One step closer to eliminating HIV [press release]. Melbourne: State Government of Victoria, 30 January 2016.
[46] Holt M, Murphy DA, Callander D, Ellard J, Rosengarten M, Kippax SC, et al Willingness to use HIV pre-exposure prophylaxis and the likelihood of decreased condom use are both associated with unprotected anal intercourse and the perceived likelihood of becoming HIV positive among Australian gay and bisexual men. Sex Transm Infect 2012; 88 258–63.
| Willingness to use HIV pre-exposure prophylaxis and the likelihood of decreased condom use are both associated with unprotected anal intercourse and the perceived likelihood of becoming HIV positive among Australian gay and bisexual men.Crossref | GoogleScholarGoogle Scholar | 22290327PubMed |
[47] Chen Y-H, Snowden JM, McFarland W, Raymond HF. Pre-exposure prophylaxis (PrEP) use, seroadaptation, and sexual behavior among men who have sex with men, San Francisco, 2004–2014. AIDS Behav 2016;
| Pre-exposure prophylaxis (PrEP) use, seroadaptation, and sexual behavior among men who have sex with men, San Francisco, 2004–2014.Crossref | GoogleScholarGoogle Scholar | 27395432PubMed |
