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RESEARCH ARTICLE

Risk factors for HIV seroconversion in homosexual men in Australia

Jonathan E. Volk A C , Garrett Prestage A , Fengyi Jin A , John Kaldor A , Jeanne Ellard B , Susan Kippax B and Andrew E. Grulich A
+ Author Affiliations
- Author Affiliations

A National Centre in HIV Epidemiology and Clinical Research, Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia.

B National Centre in HIV Social Research, Level 2, Webster Building, University of New South Wales, Sydney, NSW 2052, Australia.

C Corresponding author. Email: jvolk@itsa.ucsf.edu

Sexual Health 3(1) 45-51 https://doi.org/10.1071/SH05020
Submitted: 11 April 2005  Accepted: 4 November 2005   Published: 20 February 2006

Abstract

Background: Rates of newly acquired HIV infection are increasing in Australia, and sexual contact between men accounts for 85% of cases. Objective: To investigate behavioural risk factors for HIV seroconversion among gay and bisexual men from Sydney and Melbourne, Australia. Methods: 103 men with newly acquired HIV infection were recruited from clinics in Sydney and Melbourne and behavioural risk factor questionnaires were administered between January 2003 and October 2004. Results were compared with a cross sectional and a cohort study performed by our group that enrolled similar populations of men. Results: The majority of seroconverters (73%) reported more than five sexual partners in the last six months. Ninety-five men (92%) were able to identify a high-risk event (HRE) that they thought had led to their HIV seroconversion. Most (70%) reported receptive unprotected anal intercourse (UAI), insertive UAI, or both at their HRE. Sixteen men (16%) reported no UAI in the preceding six months including the HRE. Men were more likely to report receptive UAI at their HRE when they perceived a partner to be HIV-negative as compared with when they perceived a partner to be HIV-positive (P = 0.05). Injection drug use was reported by 22% of the men in the previous six months, and 62% reported intoxication with alcohol (≥5 drinks) or mood altering recreational drug use at the HRE. Conclusions: Gay and bisexual men who have recently seroconverted are highly sexually active and report high rates of unprotected anal intercourse and recreational drug use at the HRE.

Additional keywords: drugs, gay men, seroconverter, strategic positioning.


Acknowledgements

Financial support: The National Centre in HIV Epidemiology and Clinical Research and the National Centre in HIV Social Research are funded by the Australian Government Department of Health and Aging. The National Institute of Allergy and Infectious Diseases (grant AI52403) funds the PHAEDRA study, which provided the recruitment source for this study and funded the nurse interviews. Jonathan Volk was funded with a Fulbright Research Fellowship through the United States Department of State. The authors would like to thank the participating clinics: Taylor Square Private Clinic, 407 Doctors, AIDS Research Initiative, Holdsworth House, St. Vincent’s Hospital, Sydney Sexual Health Clinic, The Burwood Street Practice, The Centre Clinic, Prahran Market Clinic, Carlton Clinic, The Alfred Hospital, and the Melbourne Sexual Health Centre. The authors thank the PHAEDRA study staff, Jan Guerin, Pat Grey, Tim Ramacciotti, Ansari Shaik, and the study research nurses, Sophie Dinning, Robyn Richardson, Robyn Vale, Vanessa Rees, Cari Egan, Sam Miller, Rosie Newman, Mark Lacey, Richard Norris, Therese Toohey, Helen Wood, Kaye Lowe, Sally Algar, Claire McCormack, Jeff Hudson, Helen Kent, and Julie Silvers. They also express their gratitude to the men who participated in this research.


References


[1] NCHECR. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2004. Sydney: National Centre in HIV Epidemiology and Clinical Research; 2004.

[2] Kippax S,  Slavin S,  Ellard J,  Hendry O,  Richters J,  Grulich A, et al. Seroconversion in context. AIDS Care 2003; 15(6): 839–52.
CrossRef | PubMed |

[3] Hocking J,  Rodger A,  Rhodes D,  Crofts N. HIV Seroconverters: Using surveillance to characterise people with incident HIV infection in Victoria, Australia. Eur J Epidemiol 2001; 17(2): 157–61.
CrossRef | PubMed |

[4] Prestage G,  Van de Ven P,  Mao L,  Grulich A,  Kippax S,  Kaldor J. Contexts for last occasions of unprotected anal intercourse among HIV-negative gay men in Sydney: the Health in Men (HIM) cohort. AIDS Care 2005; 17(1): 23–32.
CrossRef | PubMed |

[5] Van de Ven P,  Kippax S,  Crawford J,  French J,  Prestage G,  Grulich A, et al. Sexual practices in a broad cross-sectional sample of Sydney gay men. Aust N Z J Public Health 1997; 21(7): 762–6.
PubMed |

[6] Prestage G , Van de Ven P , Knox S , Grulich A , Kippax S , Crawford J . The Sydney Gay Community Periodic Surveys, 1996–1999. Changes over time. Sydney 1999.

[7] Burcham JL,  Tindall B,  Marmor M,  Cooper DA,  Berry G,  Penny R. Incidence and risk factors for human immunodeficiency virus seroconversion in a cohort of Sydney homosexual men. Med J Aust 1989; 150(11): 634–9.
PubMed |

[8] Ruiz J,  Facer M,  Sun RK. Risk factors for human immunodeficiency virus infection and unprotected anal intercourse among young men who have sex with men. Sex Transm Dis 1998; 25(2): 100–7.
PubMed |

[9] Samuel MC,  Hessol N,  Shiboski S,  Engel RR,  Speed TP,  Winkelstein W. Factors associated with human immunodeficiency virus seroconversion in homosexual men in three San Francisco cohort studies, 1984–1989. J Acquir Immune Defic Syndr 1993; 6(3): 303–12.
PubMed |

[10] Weber AE,  Chan K,  George C,  Hogg RS,  Remis RS,  Martindale S, et al. Risk factors associated with HIV infection among young gay and bisexual men in Canada. J Acquir Immune Defic Syndr 2001; 28(1): 81–8.
PubMed |

[11] Hull P , Van de Ven P , Prestage G , Rawstorne P , Kippax S , Horn G , et al Gay community periodic survey Melbourne 2004. Sydney: University of New South Wales, National Centre in HIV Social Research Monograph; 2004.

[12] Calzavara L,  Burchell AN,  Remis RS,  Major C,  Corey P,  Myers T, et al. Delayed application of condoms is a risk factor for human immunodeficiency virus infection among homosexual and bisexual men. Am J Epidemiol 2003; 157(3): 210–7.
CrossRef | PubMed |

[13] Difranceisco W,  Ostrow DG,  Chmiel JS. Sexual adventurism, high-risk behavior, and human immunodeficiency virus-1 seroconversion among the Chicago MACS-CCS cohort, 1984 to 1992. A case-control study. Sex Transm Dis 1996; 23(6): 453–60.
PubMed |

[14] Page-Shafer K,  Veugelers PJ,  Moss AR,  Strathdee S,  Kaldor JM,  van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982–1994. Am J Epidemiol 1997; 146(7): 531–42.
PubMed |

[15] Ostrow DG,  DiFranceisco WJ,  Chmiel JS,  Wagstaff DA,  Wesch J. A case-control study of human immunodeficiency virus type 1 seroconversion and risk-related behaviors in the Chicago MACS/CCS Cohort, 1984–1992. Multicenter AIDS Cohort Study. Coping and Change Study. Am J Epidemiol 1995; 142(8): 875–83.
PubMed |

[16] Weber AE,  Craib KJ,  Chan K,  Martindale S,  Miller ML,  Cook DA, et al. Determinants of HIV serconversion in an era of increasing HIV infection among young gay and bisexual men. AIDS 2003; 17(5): 774–7.
CrossRef | PubMed |

[17] Kippax S,  Campbell D,  Van de Ven P,  Crawford J,  Prestage G,  Knox S, et al. Cultures of sexual adventurism as markers of HIV seroconversion: a case control study in a cohort of Sydney gay men. AIDS Care 1998; 10(6): 677–88.
CrossRef | PubMed |

[18] Colfax G,  Vittinghoff E,  Husnik MJ,  McKirnan D,  Buchbinder S,  Koblin B, et al. Substance use and sexual risk: a participant- and episode-level analysis among a cohort of men who have sex with men. Am J Epidemiol 2004; 159(10): 1002–12.
CrossRef | PubMed |

[19] Van de Ven P,  Kippax S,  Crawford J,  Rawstorne P,  Prestage G,  Grulich A, et al. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care 2002; 14(4): 471–80.
CrossRef | PubMed |

[20] Rosengarten M , Race K , Kippax S . “Touch wood, everthing will be OK”: Gay men’s understanding of clinical markers in sexual paractice. Sydney: University of New South Wales, National Centre in HIV Social Research; 2000.

[21] Keet IP,  Albrecht van Lent N,  Sandfort TG,  Coutinho RA,  van Griensven GJ. Orogenital sex and the transmission of HIV among homosexual men. AIDS 1992; 6(2): 223–6.
PubMed |



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