Whereas most gay men in Australia know their HIV test result, a consistent minority do not. From ... more Whereas most gay men in Australia know their HIV test result, a consistent minority do not. From Gay Community Periodic Surveys (n = 6831) conducted during 1998 in the 5 largest cities, those who did not have HIV test results (13.3% overall) comprised 10.0% in Sydney, 15.7% in Melbourne, 13.6% in Brisbane, 15.2% in Perth and 14.0% in Adelaide, representing a significant difference between cities (P < 0.001). Gay men who did not have HIV test results differed from those who did in several ways. They were on average younger (31 vs 35 years, P < 0.001) and less likely to be in professional occupations (P < 0.001). They were less likely to identify themselves as 'gay' (P < 0.001), spent less time with other gay men (P < 0.001) and had fewer gay friends (P < 0.001). They had sex with fewer different men 'in the previous 6 months' (P < 0.001) and were more likely to be in a monogamous relationship or without sexual partners at the time of the survey (P...
We examined HIV optimism and unprotected anal intercourse (UAI) in a nationwide sample of gay and... more We examined HIV optimism and unprotected anal intercourse (UAI) in a nationwide sample of gay and homosexually active men. Questionnaires were distributed throughout Australia through pornographic catalogues. 1832 men responded, 1181 (64.5%) classified as gay community attached (GCA) and 651 (35.5%) as non-GCA (NGCA). Mean HIV optimism scores tended toward scepticism rather than optimism, with no significant difference between GCA and NGCA men. Men who had UAI with regular partners were significantly more optimistic than men who did not ( P<0.001). There was a significant UAI-casual/GCA interaction ( P<0.001). GCA men who engaged in UAI-casual were significantly more optimistic than GCA men who did not ( P<0.001). Likewise, NGCA men who had UAI-casual were significantly more optimistic than NGCA men who did not ( P<0.001). These findings corroborate earlier evidence that gay men's UAI is associated with - not necessarily caused by - HIV optimism. Importantly, these d...
Summary: We set out to determine the frequency and correlates of gay men's repeated unprotect... more Summary: We set out to determine the frequency and correlates of gay men's repeated unprotected anal intercourse with casual partners (UAI-C), defined as UAI-C reported at each of 3 annual interviews. By May 1997, 659 men had completed 3 annual interviews for the Sydney Men and Sexual Health (SMASH) cohort study. For the 3 6-month periods prior to each interview, 127 men reported UAI-C during one period only; 45 reported it during 2 periods; and 20 men reported it during all 3 periods. These 20 men who had repeated UAI-C were compared with 497 men who had anal intercourse with casual partners but did not report on all 3 occasions that they had UAI-C. Logistic regression revealed that repeated UAI-C was associated with HIV-positive status, more casual partners, less favourable attitudes toward condoms and greater recreational drug use. Few gay men have repeated UAI-C but those who do run greater risk of HIV transmission.
The aim of this study was to examine gay and homosexually active men's knowledge of hepatitis... more The aim of this study was to examine gay and homosexually active men's knowledge of hepatitis C, drug use, injecting practices and testing for hepatitis C. The data were from 3039 men who participated in the Male Call 96 national telephone survey of Australian gay and homosexually active men. Altogether, 9.9% of the men had ever injected and 4.4% had injected in the 6 months prior to data collection. Injecting drug use was more common among gay identified men and gay community attached men. Among the injecting drug users, 73.4% had injected before 25 years of age. There was a fair amount of uncertainty about hepatitis C although 41.3% of the men reported having been tested (higher at 64.2% among those who had ever injected). Sixty‐five men self‐reported a hepatitis C diagnosis, 17 with HIV co‐infection. In a multivariate model, self‐report of hepatitis C diagnosis was associated with being in the 30‐39 or 40‐49 years of age brackets, better knowledge of hepatitis C, HIV positivi...
Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies tha... more Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies that gay men have devised to manage (as distinct from eliminate) risk of HIV transmission. Apart from negotiated safety and positive-positive sex, which have been practised for some ...
Australian and New Zealand Journal of Public Health, 1998
We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly ... more We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly with a view to investigating any behavioural changes after the recent improvements in antiretroviral therapies. Trends in unprotected anal intercourse were monitored through the Sydney Gay Community Periodic (cross-sectional) Surveys which were conducted at six-monthly intervals between February 1996 and February 1998. Gay men (n=2,863) were recruited and self-completed a short questionnaire at three gay venues and a sexual health clinic. There was a significant increase in unprotected anal intercourse with casual partners (but not with regular partners), applicable to both HIV positive and HIV negative men. Sexual practice was generally unrelated to ideas about recent advances in viral load testing and combination therapies.
Comprehensive, reliable, and valid measurement of prejudicial attitudes and behaviors toward lesb... more Comprehensive, reliable, and valid measurement of prejudicial attitudes and behaviors toward lesbians and gay males has been identified as a priority. A sample of undergraduate (N = 97) and high school students (N = 40) completed three reliable measures of cognitive (Modified Attitudes Toward Homosexuality Scale), affective (Affective Reactions to Homosexuality Scale), and behavioral (Homophobic Behavior of Students Scale) reactions to homosexuals. Undergraduate students' responses confirmed the three-factor structure (homophobic guilt, homophobic anger, delight) of affects in this domain, and supported the concurrent validity of the behavioral measure. Predictive validity of the behavioral scale was demonstrated by findings of the high school study which showed that students subsequently acted in accordance with their responses to this paper-and-pencil test. LISREL confirmatory factor analysis of the overarching model indicated that a tripartite (cognition-affectbehavior) measurement strategy was appropriate. This strategy may be used in future research to provide comprehensive indication of which educational interventions make a difference in improving understanding and acceptance of homosexuality.
This study aimed to develop reliable scales of HIV vaccine attitudes. Gay men were recruited at t... more This study aimed to develop reliable scales of HIV vaccine attitudes. Gay men were recruited at the 2001 Sydney Gay and Lesbian Mardi Gras Fair Day, a large gay community gathering of thousands of people. A total of 776 participants completed a questionnaire containing 38 items about HIV vaccines. Factor analysis of the responses of 585 HIV-negative/untested men revealed four distinct factors (accounting cumulatively for 24.5% of the variance): I, Comfort with Participation in HIV Vaccine Trials, Cronbach a 5 0.81; II, Confidence in HIV Vaccines/Vaccine Trials, Cronbach a 5 0.71; III, Sexual Freedom, Cronbach a 5 0.64; IV, Willingness to Participate in HIV Vaccine Trials, Cronbach a 5 0.59. Of the HIV-negative/untested men, 162 (27.7%) were likely/very likely to volunteer for HIV vaccine trials, and 422 (72.3%) were unlikely/very unlikely to do so. As preliminary evidence of construct validity, the 162 men had a higher mean score on scale I (2.79), indicating greater comfort with trial participation than their 422 counterparts (2.47, p , 0.001). As preliminary evidence of concurrent validity, the 162 men had a higher mean score on scale IV (2.79), indicating greater willingness to participate than the rest (2.22, p , 0.001). Alongside HIV vaccine trials, these scales may be a useful adjunct to social research in gay communities; to monitor and be responsive to community concerns about HIV vaccine trials as well as their potential to undermine safe sex practices.
Willingness to participate in HIV vaccine trials among a sample of men who have sex with men, wit... more Willingness to participate in HIV vaccine trials among a sample of men who have sex with men, with and without a history of commercial sex, Rio de Janeiro, Brazil
Objective: To determine whether reporting that the HIV-positive partner's viral load is undetecta... more Objective: To determine whether reporting that the HIV-positive partner's viral load is undetectable rather than detectable is associated with unprotected anal intercourse (UAI) in HIV serodiscordant gay couples. Method: A cross-sectional study nested within two cohort studies, the Health in Men (HIM) cohort of HIV-negative men, from July 2001 to December 2003 and the Positive Health (PH) cohort of HIV-positive men, from February 2002 to August 2003. The study participants were 119 men in an HIV serodiscordant regular relationship of at least 6 months duration (45 HIV-negative men from HIM, 74 HIV-positive men from PH). The main outcome measure was the occurrence of UAI within the relationship in the previous 6 months. Results: Eighty-two men reported no UAI and 37 reported some UAI. Of couples in which the HIV-positive partner's viral load was reported to be undetectable, 39.4% reported UAI compared with 20.8% of those where viral load was reported to be detectable (P ¼ 0.04). In multivariate analysis, significant predictors of UAI were younger age [odds ratio (OR), 0.94; 95% confidence interval (CI), 0.87-1.00;
Sponsorship: This study was supported by the New South Wales Health Department and implemented in... more Sponsorship: This study was supported by the New South Wales Health Department and implemented in association with the AIDS Council of New South Wales and People Living With HIV/AIDS (NSW) Inc. The National Centre in HIV Social Research and the National Centre in HIV ...
Australian and New Zealand Journal of Public Health, 1997
The aim of this study was to provide current data on the sexual practices in a broad cross-sectio... more The aim of this study was to provide current data on the sexual practices in a broad cross-sectional sample of gay and homosexually active men in Sydney. Anonymous, short questionnaires were completed by 1611 gay men recruited at the 1996 Gay and Lesbian Mardi Gras Fair Day or at one of six venues (including two sexual health centres) across the metropolitan area during the following week. The sample was diverse, but the men tended to be of Anglo-Australian background, well educated, professionally employed, attached to gay community and gay identified. They mainly had sex with other men rather than with men and women. Most (86.0 per cent) had been tested for human immunodeficiency virus. Excluding 241 men recruited in sexual health centres, 11.2 per cent were HIV-positive and 73.4 per cent were negative. Where it occurred in regular relationships, unprotected anal intercourse was usually between seroconcordant partners (78.5 per cent). Unprotected anal intercourse between discordant or nonconcordant regular partners was much less common, and in about half the cases involved withdrawal prior to ejaculation exclusively rather than ejaculation inside. Almost 12 per cent of the men had at least 'occasionally' engaged in unprotected anal intercourse with a casual partner in the previous six months, with approximately half of these men having adopted a withdrawal strategy on every occasion. We conclude that short surveys can provide valuable and timely data on sexual practices in a broad cross-sectional sample of gay and homosexually active men. Key messages for those involved in gay men's education are the high rates of unprotected anal intercourse between casual partners and the extensive practice of withdrawal.
Whereas most gay men in Australia know their HIV test result, a consistent minority do not. From ... more Whereas most gay men in Australia know their HIV test result, a consistent minority do not. From Gay Community Periodic Surveys (n = 6831) conducted during 1998 in the 5 largest cities, those who did not have HIV test results (13.3% overall) comprised 10.0% in Sydney, 15.7% in Melbourne, 13.6% in Brisbane, 15.2% in Perth and 14.0% in Adelaide, representing a significant difference between cities (P < 0.001). Gay men who did not have HIV test results differed from those who did in several ways. They were on average younger (31 vs 35 years, P < 0.001) and less likely to be in professional occupations (P < 0.001). They were less likely to identify themselves as 'gay' (P < 0.001), spent less time with other gay men (P < 0.001) and had fewer gay friends (P < 0.001). They had sex with fewer different men 'in the previous 6 months' (P < 0.001) and were more likely to be in a monogamous relationship or without sexual partners at the time of the survey (P...
We examined HIV optimism and unprotected anal intercourse (UAI) in a nationwide sample of gay and... more We examined HIV optimism and unprotected anal intercourse (UAI) in a nationwide sample of gay and homosexually active men. Questionnaires were distributed throughout Australia through pornographic catalogues. 1832 men responded, 1181 (64.5%) classified as gay community attached (GCA) and 651 (35.5%) as non-GCA (NGCA). Mean HIV optimism scores tended toward scepticism rather than optimism, with no significant difference between GCA and NGCA men. Men who had UAI with regular partners were significantly more optimistic than men who did not ( P<0.001). There was a significant UAI-casual/GCA interaction ( P<0.001). GCA men who engaged in UAI-casual were significantly more optimistic than GCA men who did not ( P<0.001). Likewise, NGCA men who had UAI-casual were significantly more optimistic than NGCA men who did not ( P<0.001). These findings corroborate earlier evidence that gay men's UAI is associated with - not necessarily caused by - HIV optimism. Importantly, these d...
Summary: We set out to determine the frequency and correlates of gay men's repeated unprotect... more Summary: We set out to determine the frequency and correlates of gay men's repeated unprotected anal intercourse with casual partners (UAI-C), defined as UAI-C reported at each of 3 annual interviews. By May 1997, 659 men had completed 3 annual interviews for the Sydney Men and Sexual Health (SMASH) cohort study. For the 3 6-month periods prior to each interview, 127 men reported UAI-C during one period only; 45 reported it during 2 periods; and 20 men reported it during all 3 periods. These 20 men who had repeated UAI-C were compared with 497 men who had anal intercourse with casual partners but did not report on all 3 occasions that they had UAI-C. Logistic regression revealed that repeated UAI-C was associated with HIV-positive status, more casual partners, less favourable attitudes toward condoms and greater recreational drug use. Few gay men have repeated UAI-C but those who do run greater risk of HIV transmission.
The aim of this study was to examine gay and homosexually active men's knowledge of hepatitis... more The aim of this study was to examine gay and homosexually active men's knowledge of hepatitis C, drug use, injecting practices and testing for hepatitis C. The data were from 3039 men who participated in the Male Call 96 national telephone survey of Australian gay and homosexually active men. Altogether, 9.9% of the men had ever injected and 4.4% had injected in the 6 months prior to data collection. Injecting drug use was more common among gay identified men and gay community attached men. Among the injecting drug users, 73.4% had injected before 25 years of age. There was a fair amount of uncertainty about hepatitis C although 41.3% of the men reported having been tested (higher at 64.2% among those who had ever injected). Sixty‐five men self‐reported a hepatitis C diagnosis, 17 with HIV co‐infection. In a multivariate model, self‐report of hepatitis C diagnosis was associated with being in the 30‐39 or 40‐49 years of age brackets, better knowledge of hepatitis C, HIV positivi...
Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies tha... more Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies that gay men have devised to manage (as distinct from eliminate) risk of HIV transmission. Apart from negotiated safety and positive-positive sex, which have been practised for some ...
Australian and New Zealand Journal of Public Health, 1998
We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly ... more We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly with a view to investigating any behavioural changes after the recent improvements in antiretroviral therapies. Trends in unprotected anal intercourse were monitored through the Sydney Gay Community Periodic (cross-sectional) Surveys which were conducted at six-monthly intervals between February 1996 and February 1998. Gay men (n=2,863) were recruited and self-completed a short questionnaire at three gay venues and a sexual health clinic. There was a significant increase in unprotected anal intercourse with casual partners (but not with regular partners), applicable to both HIV positive and HIV negative men. Sexual practice was generally unrelated to ideas about recent advances in viral load testing and combination therapies.
Comprehensive, reliable, and valid measurement of prejudicial attitudes and behaviors toward lesb... more Comprehensive, reliable, and valid measurement of prejudicial attitudes and behaviors toward lesbians and gay males has been identified as a priority. A sample of undergraduate (N = 97) and high school students (N = 40) completed three reliable measures of cognitive (Modified Attitudes Toward Homosexuality Scale), affective (Affective Reactions to Homosexuality Scale), and behavioral (Homophobic Behavior of Students Scale) reactions to homosexuals. Undergraduate students' responses confirmed the three-factor structure (homophobic guilt, homophobic anger, delight) of affects in this domain, and supported the concurrent validity of the behavioral measure. Predictive validity of the behavioral scale was demonstrated by findings of the high school study which showed that students subsequently acted in accordance with their responses to this paper-and-pencil test. LISREL confirmatory factor analysis of the overarching model indicated that a tripartite (cognition-affectbehavior) measurement strategy was appropriate. This strategy may be used in future research to provide comprehensive indication of which educational interventions make a difference in improving understanding and acceptance of homosexuality.
This study aimed to develop reliable scales of HIV vaccine attitudes. Gay men were recruited at t... more This study aimed to develop reliable scales of HIV vaccine attitudes. Gay men were recruited at the 2001 Sydney Gay and Lesbian Mardi Gras Fair Day, a large gay community gathering of thousands of people. A total of 776 participants completed a questionnaire containing 38 items about HIV vaccines. Factor analysis of the responses of 585 HIV-negative/untested men revealed four distinct factors (accounting cumulatively for 24.5% of the variance): I, Comfort with Participation in HIV Vaccine Trials, Cronbach a 5 0.81; II, Confidence in HIV Vaccines/Vaccine Trials, Cronbach a 5 0.71; III, Sexual Freedom, Cronbach a 5 0.64; IV, Willingness to Participate in HIV Vaccine Trials, Cronbach a 5 0.59. Of the HIV-negative/untested men, 162 (27.7%) were likely/very likely to volunteer for HIV vaccine trials, and 422 (72.3%) were unlikely/very unlikely to do so. As preliminary evidence of construct validity, the 162 men had a higher mean score on scale I (2.79), indicating greater comfort with trial participation than their 422 counterparts (2.47, p , 0.001). As preliminary evidence of concurrent validity, the 162 men had a higher mean score on scale IV (2.79), indicating greater willingness to participate than the rest (2.22, p , 0.001). Alongside HIV vaccine trials, these scales may be a useful adjunct to social research in gay communities; to monitor and be responsive to community concerns about HIV vaccine trials as well as their potential to undermine safe sex practices.
Willingness to participate in HIV vaccine trials among a sample of men who have sex with men, wit... more Willingness to participate in HIV vaccine trials among a sample of men who have sex with men, with and without a history of commercial sex, Rio de Janeiro, Brazil
Objective: To determine whether reporting that the HIV-positive partner's viral load is undetecta... more Objective: To determine whether reporting that the HIV-positive partner's viral load is undetectable rather than detectable is associated with unprotected anal intercourse (UAI) in HIV serodiscordant gay couples. Method: A cross-sectional study nested within two cohort studies, the Health in Men (HIM) cohort of HIV-negative men, from July 2001 to December 2003 and the Positive Health (PH) cohort of HIV-positive men, from February 2002 to August 2003. The study participants were 119 men in an HIV serodiscordant regular relationship of at least 6 months duration (45 HIV-negative men from HIM, 74 HIV-positive men from PH). The main outcome measure was the occurrence of UAI within the relationship in the previous 6 months. Results: Eighty-two men reported no UAI and 37 reported some UAI. Of couples in which the HIV-positive partner's viral load was reported to be undetectable, 39.4% reported UAI compared with 20.8% of those where viral load was reported to be detectable (P ¼ 0.04). In multivariate analysis, significant predictors of UAI were younger age [odds ratio (OR), 0.94; 95% confidence interval (CI), 0.87-1.00;
Sponsorship: This study was supported by the New South Wales Health Department and implemented in... more Sponsorship: This study was supported by the New South Wales Health Department and implemented in association with the AIDS Council of New South Wales and People Living With HIV/AIDS (NSW) Inc. The National Centre in HIV Social Research and the National Centre in HIV ...
Australian and New Zealand Journal of Public Health, 1997
The aim of this study was to provide current data on the sexual practices in a broad cross-sectio... more The aim of this study was to provide current data on the sexual practices in a broad cross-sectional sample of gay and homosexually active men in Sydney. Anonymous, short questionnaires were completed by 1611 gay men recruited at the 1996 Gay and Lesbian Mardi Gras Fair Day or at one of six venues (including two sexual health centres) across the metropolitan area during the following week. The sample was diverse, but the men tended to be of Anglo-Australian background, well educated, professionally employed, attached to gay community and gay identified. They mainly had sex with other men rather than with men and women. Most (86.0 per cent) had been tested for human immunodeficiency virus. Excluding 241 men recruited in sexual health centres, 11.2 per cent were HIV-positive and 73.4 per cent were negative. Where it occurred in regular relationships, unprotected anal intercourse was usually between seroconcordant partners (78.5 per cent). Unprotected anal intercourse between discordant or nonconcordant regular partners was much less common, and in about half the cases involved withdrawal prior to ejaculation exclusively rather than ejaculation inside. Almost 12 per cent of the men had at least 'occasionally' engaged in unprotected anal intercourse with a casual partner in the previous six months, with approximately half of these men having adopted a withdrawal strategy on every occasion. We conclude that short surveys can provide valuable and timely data on sexual practices in a broad cross-sectional sample of gay and homosexually active men. Key messages for those involved in gay men's education are the high rates of unprotected anal intercourse between casual partners and the extensive practice of withdrawal.
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