Risk factors for HIV seroconversion in men who have sex with men in Victoria, Australia: results from a sentinel surveillance system
Rebecca J. Guy A H , Tim Spelman B , Mark Stoove B , Carol El-Hayek B , Jane Goller B , Christopher K. Fairley C D , David Leslie E , BK Tee F , Norman Roth G , Andrew E. Grulich A and Margaret E. Hellard BA National Centre in HIV Epidemiology and Clinical Research, 45 Beach Street, Coggee, NSW 2031, Australia.
B Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
C Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia.
D School of Population Health, University of Melbourne, 207 Bouverie Street, Melbourne, Vic. 3010, Australia.
E Victorian Infectious Diseases Reference Laboratory, 10 Wreckyn Street, North Melbourne, Vic. 3051, Australia.
F The Centre Clinic, 22 Fitzroy Street, St Kilda, Vic. 3182, Australia.
G Prahran Market Clinic, 163 Commercial Road, Prahran, Vic. 3141, Australia.
H Corresponding author. Email: Rguy@nchecr.unsw.edu.au
Sexual Health 8(3) 319-329 https://doi.org/10.1071/SH10095
Submitted: 7 August 2010 Accepted: 17 December 2010 Published: 23 May 2011
Abstract
Objectives: HIV diagnosis rates in men who have sex with men (MSM) began increasing in Australia 10 years ago, and there has been a major resurgence of syphilis. We determined predictors of HIV positivity and seroconversion among MSM in Victoria, Australia. Methods: We conducted a retrospective longitudinal analysis of data from MSM who underwent HIV testing between April 2006 and June 2009 at three primary care clinics. Logistic regression was used to determine predictors of HIV positivity and seroconversion. Results: During the study period, 7857 MSM tested for HIV. Overall HIV positivity was 1.86% (95% confidence interval (CI): 1.6–2.2). There were 3272 repeat testers followed for 4837 person-years (PY); 60 seroconverted and HIV incidence was 1.24 (95% CI: 0.96–1.60) per 100 PY. Independent predictors of HIV seroconversion were: an infectious syphilis diagnosis within the last 2 years (adjusted hazard ratio (AHR) = 2.5, 95% CI: 1.1–5.7), reporting six or more anal sex partners in the past 6 months (AHR = 3.3, 95% CI: 1.8–6.3), reporting an HIV-positive current regular partner (AHR = 3.4, 95% CI: 1.1–10.6) and reporting inconsistent condom use with casual partners in the past 6 months (AHR = 4.4, 95% CI: 1.7–11.5). Conclusion: Our results call for HIV prevention to target high-risk MSM, including men with a recent syphilis diagnosis or a high numbers of partners, men who have unprotected anal sex with casual partners and men in serodiscordant relationships. The HIV incidence estimate will provide a baseline to enable public health officials to measure the effectiveness of future strategies.
Additional keywords: HIV incidence, men who have sex with men, syphilis.
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