Despite increased HIV prevention among gay and bisexual men in Australia, some men remain underprotected

HIV prevention coverage is expanding among gay and bisexual men in Australia, but some men remain under-protected. Gay and bisexual men under the age of 25, bisexual men of all ages, and men living in suburban areas with fewer gay men are at higher risk for HIV and have lower levels of preventive coverage.

The addition of PrEP and viral suppression to the arsenal of HIV prevention strategies has reduced HIV infection rates among gay and bisexual men, including in Australia. However, access to and use of HIV prevention strategies varies by subpopulation, and some groups of gay and bisexual men have high rates of HIV infection, including in Australia, a country with strong HIV prevention policies. or are at high risk of HIV infection. . Furthermore, the wide range of HIV prevention strategies, many of which are used in combination, makes it difficult to monitor and assess HIV prevention techniques and their risk of HIV infection within specific groups.

Recent articles based on repeated survey data collected between 2017 and 2021 AIDS and behavior analyzed the wide range of HIV prevention strategies used by gay and bisexual men in Australia and determined the level of ‘safe sex’ (‘net HIV prevention coverage’) achieved by these men using safe sex strategies. Did. These strategies included not engaging in anal sex. Consistent condom use. HIV positive, receiving treatment for undetectable viral load, and reporting condomless anal sex with casual male partners. She is HIV negative and on her PrEP and reports condomless anal sex with casual male partners.

Researchers also found that which groups of men were more likely to be HIV negative or untested, not taking PrEP, and engaging in riskier sexual behaviors such as having condomless anal sex with casual male partners. We sought to determine who was at greatest risk for HIV infection.

The authors found that the overall net HIV prevention rate among respondents increased from 70% to 75%. Increases in prophylactic coverage during sex with a causal partner were driven by increased PrEP use and higher levels of viral suppression among respondents living with HIV, and decreased condom use over the same 5-year period. I canceled it. However, the risk of HIV infection and the prevention methods used vary by age, sexual identity, length of residence in the country for those born outside Australia, and the proportion of gay men living in the suburb where the respondent resides.

age difference

While respondents under 25 years of age had the lowest HIV infection rates, they also had the lowest prevention rates and the highest risk of HIV infection. They were most likely to report having had anal sex with a casual partner. They were most likely to report consistently using condoms with casual partners, but also least likely to use PrEP when having condomless sex (although this PrEP use in this age group more than doubled from 9% in 2017 to 20% in 2021).

Respondents aged 25 to 44 were most likely to use PrEP when having condomless sex (which doubled from 19% to nearly 40% in five years), but their consistent use of condoms Usage has fallen by almost half from a high of about 40% in 2017. The prevention rate for this age group (71% in 2017) increased slightly, and the proportion of people in this age group who said they were at high risk of acquiring HIV decreased from almost 30% to just over 20%. did.

The oldest age group (45 years and older) had the highest protection rate and the lowest proportion of men at highest risk of HIV infection. This group was most likely to be living with HIV and have an undetectable viral load. Most likely to report no anal sex with casual partners, consistent condom use decreased over time, but PrEP use among those who reported condomless sex decreased by 12 in 2017 % to 31% in 2021, more than doubling.

Country of birth and length of stay in Australia

There was a slight increase in HIV prevention rates among Australian-born respondents (from 69% in 2017 to 74% in 2021), and a decrease in the proportion of respondents at high risk of HIV infection over the same period (from 31% to 74% in 2021). 26%). In contrast, HIV prevention rates among overseas-born respondents who have lived in Australia for less than two years remained unchanged between 2019 and 2021 (the only year in which the survey asked about length of stay), but recently The proportion of respondents who came to Australia and were at high risk of HIV infection also fell. Vaccination rates were highest among overseas-born respondents who had lived in Australia for more than two years (from 2019 to 2021, vaccination rates increased from 3 in 4 to almost 4 in 5 people) Did). These highest levels were primarily due to a relatively stable proportion of respondents reporting consistent condom use and no anal intercourse, as well as an increase in her PrEP use during condomless sex. Thing.

sexual identity

Survey respondents who identified as gay took higher levels of precautions (and had lower levels of casual sex with risk of infection) than respondents who identified as bisexual or other (was low). Men who identified as gay had higher levels of their girlfriends’ PrEP use during condomless sex. Among respondents who identified as gay, a higher proportion of their HIV-positive girlfriends with undetectable viral load reported condomless sex. Respondents who were bisexual or had another identity were more likely to report consistent condom use.

live around other gay men

Prevention rates were consistently higher among respondents living in suburbs with a gay residential population of 10% or more, increasing from 73% in 2017 to 88% in 2021. In suburbs with large numbers of gay residents, this was driven by an almost double increase. PrEP use by HIV-negative respondents who reported condomless sex with a casual partner (23% in 2017, 52% in 2021) and HIV-positive respondents who had condomless sex without a detectable viral load. Among respondents living in gay suburbs, the proportion who say they have had sex that puts them at high risk of contracting HIV has increased from 1 in 4 (25%) to about 1 in 10 over a five-year period. (11%).

In contrast, among respondents in suburbs with less than 10% gay populations (70% in 2017 to 74% in 2021), the rate of PrEP use during condomless sex more than doubled in five years However, the rate of improvement in the prevention rate was small. Data has been collected. However, they were consistently more likely to report having sex that put them at higher risk of HIV infection than respondents in suburbs with 10% or more of their residents who were gay.

conclusion

Although Australia’s HIV response remains strong, inequalities in net HIV prevention coverage, HIV risk, and the range of prevention strategies used persist. High HIV risk and low prevention rates among young gay and bisexual men, men who identify as bisexual, and men living in low-gay suburban areas mean Australia will not be able to meet the UNAIDS-recommended 95% prevention target. This is the reason why it cannot be achieved.

The authors suggest that those working to expand HIV prevention coverage in affected communities should avoid focusing on a single strategy, including condoms, PrEP, and undetectable viral load. We recommend supporting access to a variety of effective prevention strategies.

References