Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
REVIEW

Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections

Iryna B. Zablotska A B C , Susan Kippax B , Andrew Grulich A , Martin Holt B and Garrett Prestage A
+ Author Affiliations
- Author Affiliations

A National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2052, Australia.

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

C Corresponding author. Email: izablotska@nchecr.unsw.edu.au

Sexual Health 8(3) 272-279 https://doi.org/10.1071/SH10125
Submitted: 29 September 2010  Accepted: 27 January 2011   Published: 23 May 2011

Abstract

Background: The Australian HIV and sexually transmissible infection (STI) behavioural surveillance system (the repeated cross-sectional Gay Community Periodic Surveys, GCPS) has been conducted since 1998 and covers six main Australian jurisdictions. In this paper, we review its history and methodology, and the available indicators, their trends and their use. Methods:We describe the design and history of GCPS. For analyses of indicators, we use Pearson’s χ2-test and test for trend where appropriate. Results: About 90% of gay men in Australia have been tested for HIV (60% to 70% of men who were not HIV-positive) have been tested as recommended in the preceding 12 months. STI testing levels (~70% in the preceding 12 months) are high, but remain insufficient for STI prevention. In general, unprotected anal intercourse with regular (UAIR) and casual (UAIC) sex partners has increased over time. The prevalence and increasing trends in UAIR were similar across jurisdictions (P-trend <0.01), while trends in UAIC differed across the states: during 2001–08, UAIC declined in NSW (P-trend <0.01) and increased elsewhere (P-trend <0.01). Trends in UAIC were associated with HIV diagnoses. Conclusion: This review of the design, implementation and findings of the Australian HIV/STI behavioural surveillance highlights important lessons for HIV/STI behavioural surveillance among homosexual men, particularly the need for consistent data collection over time and across jurisdictions. Investment in systematic behavioural surveillance appears to result in a better understanding of the HIV epidemic, the availability of a warning system and a better targeted HIV prevention strategy.

Additional keywords: homosexual, men who have sex with men, sexual behaviour, testing.


References

[1]  Grulich AE, Kaldor JM. Trends in HIV incidence in homosexual men in developed countries. Sex Health 2008; 5 113–8.
Trends in HIV incidence in homosexual men in developed countries.CrossRef |

[2]  van Griensven F, de Lind van Wijngaarden JW, Baral S, Grulich A. The global epidemic of HIV infection among men who have sex with men. Curr Opin HIV AIDS 2009; 4 300–7.
The global epidemic of HIV infection among men who have sex with men.CrossRef |

[3]  UNAIDS/WHO Working Group of Global HIV/AIDS and STI Surveillance. Guidelines for second generation HIV surveillance. Geneva, UNAIDS; 2000.

[4]  Elford J, Jeannin A, Spencer B, Gervasoni JP, van de Laar MJ, Dubois-Arber F. HIV and STI behavioural surveillance among men who have sex with men in Europe. Euro Surveill 2009; 14 19 414

[5]  Zaba B, Slaymaker E, Urassa M, Boerma JT. The role of behavioral data in HIV surveillance. AIDS 2005; 19 S39–52.
The role of behavioral data in HIV surveillance.CrossRef |

[6]  Garnett GP, Garcia-Calleja JM, Rehle T, Gregson S. Behavioural data as an adjunct to HIV surveillance data. Sex Transm Infect 2006; 82 i57–62.
Behavioural data as an adjunct to HIV surveillance data.CrossRef |

[7]  McDonald AM, Crofts N, Blumer CE, Gertig DM, Patten JJ, Roberts M, et al The pattern of diagnosed HIV infection in Australia, 1984–1992. AIDS 1994; 8 513–20.
The pattern of diagnosed HIV infection in Australia, 1984–1992.CrossRef |

[8]  Kippax S, Crawford J, Davis M, Rodden P, Dowsett G. Sustaining safe sex: a longitudinal study of a sample of homosexual men. AIDS 1993; 7 257–64.
Sustaining safe sex: a longitudinal study of a sample of homosexual men.CrossRef |

[9]  Kippax S, Crawford J, Rodden P, Noble J. Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample. Aust J Public Health 1995; 19 132–8.
Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample.CrossRef |

[10]  Prestage G, Ferris J, Grierson J, Thorpe R, Zablotska I, Imrie J, et al Homosexual men in Australia: population, distribution and HIV prevalence. Sex Health 2008; 5 97–102.
Homosexual men in Australia: population, distribution and HIV prevalence.CrossRef |

[11]  Rehle T, Lazzari S, Dallabetta G, Samoah-Odei E.. Second-generation HIV surveillance: better data for decision-making. Bull World Health Organ 2004; 82 121–7.

[12]  Imrie J, Frankland A. HIV/AIDS, hepatitis and sexually transmissible infections in Australia: Annual report of trends in behaviour 2008. Sydney: National Centre in HIV Social Research, University of New South Wales; 2008.

[13]  Altman D. Power and community: organizational and cultural responses to AIDS. London: Taylor and Francis; 1994.

[14]  Bernard D, Kippax S, Baxter D. Effective partnership and adequate investment underpin a successful response: key factors in dealing with HIV increases. Sex Health 2008; 5 193–201.
Effective partnership and adequate investment underpin a successful response: key factors in dealing with HIV increases.CrossRef |

[15]  Australian Bureau of Statistics. Population by age and sex, Australian states and territories, June 2009, catalogue no. 3201.0. Canberra: Australian Bureau of Statistics; 2010.

[16]  Zablotska I, Holt M, Prestage G. Changes in gay men’s participation in gay community life: implications for HIV prevention, surveillance and research. AIDS Behav 2010;
Changes in gay men’s participation in gay community life: implications for HIV prevention, surveillance and research.CrossRef |

[17]  Prestage G, Jin F, Zablotska I, Grulich A, Imrie J, Kaldor J, et al Trends in agreements between regular partners among gay men in Sydney, Melbourne and Brisbane, Australia. AIDS Behav 2008; 12 513–20.
Trends in agreements between regular partners among gay men in Sydney, Melbourne and Brisbane, Australia.CrossRef |

[18]  Zablotska IB, Grulich AE, de Witt J, Prestage G. Casual sexual encounters among gay men: familiarity, trust and unprotected anal intercourse. AIDS Behav 2011; in press.
Casual sexual encounters among gay men: familiarity, trust and unprotected anal intercourse.CrossRef |

[19]  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 |

[20]  Marcus U, Voss L, Kollan C, Hamouda O. HIV incidence increasing in MSM in Germany: factors influencing infection dynamics. Euro Surveill 2006; 11 157–60.

[21]  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 |

[22]  Zablotska IB, Prestage G, Grulich AE, Imrie J. Differing trends in sexual risk behaviours in three Australian states: New South Wales, Victoria and Queensland, 1998–2006. Sex Health 2008; 5 125–30.
Differing trends in sexual risk behaviours in three Australian states: New South Wales, Victoria and Queensland, 1998–2006.CrossRef |

[23]  Zablotska IB, Prestage G, Middleton M, Wilson D, Grulich AE. Contemporary HIV diagnoses trends in Australia can be predicted by trends in unprotected anal intercourse among gay men. AIDS 2010; 24 1955–58.
Contemporary HIV diagnoses trends in Australia can be predicted by trends in unprotected anal intercourse among gay men.CrossRef |

[24]  Prestage G, Jin F, Zablotska IB, Imrie J, Grulich AE, Pitts M. Trends in HIV testing among homosexual and bisexual men in eastern Australian states. Sex Health 2008; 5 119–23.
Trends in HIV testing among homosexual and bisexual men in eastern Australian states.CrossRef |

[25]  Adam PC, de Wit JB, Toskin I, Mathers BM, Nashkhoev M, Zablotska I, et al Estimating levels of HIV testing, HIV prevention coverage, HIV knowledge, and condom use among men who have sex with men (MSM) in low-income and middle-income countries. J Acquir Immune Defic Syndr 2009; 52 S143–51.
Estimating levels of HIV testing, HIV prevention coverage, HIV knowledge, and condom use among men who have sex with men (MSM) in low-income and middle-income countries.CrossRef |

[26]  Sanchez T, Finlayson T, Drake A, Behel S, Cribbin M, Dinenno E, et al Human immunodeficiency virus (HIV) risk, prevention, and testing behaviors – United States, National HIV Behavioral Surveillance System: men who have sex with men, November 2003–April 2005. MMWR Surveill Summ 2006; 55 1–16.

[27]  Mayor S. HIV testing in UK hospitals is a “lottery”, studies warn. BMJ 2010; 340 c2255
HIV testing in UK hospitals is a “lottery”, studies warn.CrossRef |

[28]  Mikolajczak J, Hospers HJ, Kok G. Reasons for not taking an HIV-test among untested men who have sex with men: an internet study. AIDS Behav 2006; 10 431–5.
Reasons for not taking an HIV-test among untested men who have sex with men: an internet study.CrossRef |

[29]  Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M. Barriers to HIV testing in Europe: a systematic review. Eur J Public Health 2010; 20 422–32.
Barriers to HIV testing in Europe: a systematic review.CrossRef |

[30]  Sexually Transmissible Infections in Gay Men Action Group (STIGMA). Sexually transmitted infection testing guidelines for men who have sex with men (MSM). Endorsed by the Australian Chapter of Sexual Health Medicine. STIGMA; 2005. Available online at: www.stigma.net.au [verified February 2011].

[31]  Prestage G, Jin F, Zablotska I, Imrie J, Kaldor JM, Grulich AE. Trends in HIV prevalence among homosexual and bisexual men in eastern Australian states. Sex Health 2008; 5 103–7.
Trends in HIV prevalence among homosexual and bisexual men in eastern Australian states.CrossRef |

[32]  Prestage G, Mao L, Kippax S, Jin F, Hurley M, Grulich A, et al Use of viral load to negotiate condom use among gay men in Sydney, Australia. AIDS Behav 2009; 13 645–51.
Use of viral load to negotiate condom use among gay men in Sydney, Australia.CrossRef |

[33]  Zablotska IB, Imrie J, Bourne C, Grulich AE, Frankland A, Prestage G. Improvements in sexual health testing among gay men in Sydney, Australia, 2003–2007. Int J STD AIDS 2008; 19 758–60.
Improvements in sexual health testing among gay men in Sydney, Australia, 2003–2007.CrossRef |

[34]  Hallett TB, Garnett GP. Has global HIV incidence peaked? Lancet 2006; 368 116–7.
Has global HIV incidence peaked?CrossRef |

[35]  Clements MS, Prestage G, Grulich A, Van de Ven P, Kippax S, Law MG. Modeling trends in HIV incidence among homosexual men in Australia 1995–2006. J Acquir Immune Defic Syndr 2004; 35 401–6.
Modeling trends in HIV incidence among homosexual men in Australia 1995–2006.CrossRef |

[36]  Stall RD, Hays RB, Waldo CR, Ekstrand M, McFarland W. The gay ‘90s: a review of research in the 1990s on sexual behavior and HIV risk among men who have sex with men. AIDS 2000; 14 S101–14.
The gay ‘90s: a review of research in the 1990s on sexual behavior and HIV risk among men who have sex with men.CrossRef |

[37]  Zablotska IB, Imrie J, Prestage G, Crawford J, Rawsthorne 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. http://www.informaworld.com/smpp/title~db=all~content=t713403300~tab=issueslist~branches=21-v21
Gay men’s current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing?CrossRef |

[38]  Lansky A, MacKellar D, Gallagher KM, Lin LS, Sullivan PS, Onorato IM. Evaluation of the new National HIV Behavioral Surveillance System (NHBS) is imperative. Sex Transm Dis 2006; 33 272–3.
Evaluation of the new National HIV Behavioral Surveillance System (NHBS) is imperative.CrossRef |

[39]  MacKellar DA, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men – a national application of venue-based, time-space sampling. Public Health Rep 2007; 122 39–47.

[40]  Paquette D, Kropp R, Cule S, Wylie J, Husbands W, Myers T, et al. HIV prevalence and associated risk behaviours among men who have sex with men (MSM) in Canada. XVII International AIDS Conference, Mexico City, Mexico, 10 July 2008. Abstract no. TUPE0252.



Rent Article (via Deepdyve) Export Citation Cited By (46)

View Altmetrics