Differing trends in sexual risk behaviours in three Australian states: New South Wales, Victoria and Queensland, 1998-2006

Iryna B. Zablotska; Garrett Prestage; Andrew E. Grulich; John Imrie

doi:10.1071/sh07076

Differing trends in sexual risk behaviours in three Australian states: New South Wales, Victoria and Queensland, 1998-2006

Sexual Health ◽

10.1071/sh07076 ◽

2008 ◽

Vol 5 (2) ◽

pp. 125 ◽

Cited By ~ 29

Author(s):

Iryna B. Zablotska ◽

Garrett Prestage ◽

Andrew E. Grulich ◽

John Imrie

Keyword(s):

Hiv Risk ◽

New South ◽

New South Wales ◽

Anal Intercourse ◽

Unprotected Anal Intercourse ◽

Risk Behaviours ◽

Gay Community ◽

South Wales ◽

Behavioural Surveillance ◽

Hiv Serostatus

Background: In Australia, the HIV epidemic is concentrated among gay men. In recent years, the number of new diagnoses stabilised in New South Wales (NSW), but increased in other states. We reviewed the trends in sexual behaviours to explain this difference. Methods: We used the Gay Community Periodic Surveys in NSW, Victoria and Queensland during 1998–2006 and restricted analyses to the 30–49 year olds who contribute most of the HIV cases. We used the χ2-test for trends in unprotected anal intercourse with casual partners (UAIC) and regular partners, number of partners, type of relationships, knowledge of HIV serostatus and its disclosure. We compared behaviours of HIV-positive and -negative men and men across states using logistic regression adjusted for the year of report. Results: Trends in behaviours differed across the states: following a period of increase, UAIC prevalence declined in NSW since 2001, but continued to increase in Victoria and Queensland. There were other changes in NSW that were not observed in Victoria and Queensland: a decline in factors increasing HIV risk (the proportions of men with multiple sex partners and men engaging in UAIC and not knowing or not disclosing HIV serostatus) and an increase in behaviours reducing it (the proportions of men in monogamous relationships and men disclosing HIV serostatus while having UAIC). Conclusion: There were patterns of declining HIV risk behaviours in NSW, and increasing risk behaviours elsewhere, that mirrored recent changes in HIV case notifications in Australia. These data suggest that behavioural surveillance can predict changes in HIV epidemiology.

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Using mathematical modelling to help explain the differential increase in HIV incidence in New South Wales, Victoria and Queensland: importance of other sexually transmissible infections

Sexual Health ◽

10.1071/sh07099 ◽

2008 ◽

Vol 5 (2) ◽

pp. 169 ◽

Cited By ~ 18

Author(s):

Alexander Hoare ◽

David P. Wilson ◽

David G. Regan ◽

John Kaldor ◽

Matthew G. Law

Keyword(s):

New South ◽

New South Wales ◽

Fold Increase ◽

Anal Intercourse ◽

Unprotected Anal Intercourse ◽

Biological Data ◽

Biological Factor ◽

South Wales ◽

Sexually Transmissible Infections ◽

Sex With Men

Background: Since 1999 there has been an increase in the number of HIV diagnoses in Australia, predominantly among men who have sex with men (MSM), but the magnitude of increase differs between states: ~7% rise in New South Wales, ~96% rise in Victoria, and ~68% rise in Queensland. Methods: Epidemiological, clinical, behavioural and biological data were collated into a mechanistic mathematical model to explore possible reasons for this increase in HIV notifications in MSM. The model was then used to make projections to 2015 under various scenarios. Results: The model suggests that trends in clinical and behavioural parameters, including increases in unprotected anal intercourse, cannot explain the magnitude of the observed rise in HIV notifications, without a substantial increase in a ‘transmission-increasing’ factor. We suggest that a highly plausible biological factor is an increase in the prevalence of other sexually transmissible infections (STI). It was found that New South Wales required an ~2-fold increase in other STI to match the data, Victoria needed an ~11-fold increase, and Queensland required an ~9-fold increase. This is consistent with observed trends in Australia for some STI in recent years. Future projections also indicate that the best way to control the current rise in HIV notifications is to reduce the prevalence of other STI and to promote condom use, testing for HIV, and initiation of early treatment in MSM diagnosed during primary infection. Conclusions: Our model can explain the recent rise in HIV notifications with an increase in the prevalence of other STI. This analysis highlights that further investigation into the causes and impact of other STI is warranted in Australia, particularly in Victoria.

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Hiv Risk Behaviour of Idus Before, During and After Imprisonment in New South Wales

Addiction Research ◽

10.3109/16066359609010754 ◽

1996 ◽

Vol 4 (2) ◽

pp. 151-160 ◽

Cited By ~ 33

Author(s):

Kate Dolan ◽

Alex Wodak ◽

Wayne Hall ◽

Matt Gaughwin ◽

Fiona Rae

Keyword(s):

Hiv Risk ◽

New South ◽

New South Wales ◽

Risk Behaviour ◽

South Wales

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27. CAN UNPROTECTED ANAL INTERCOURSE WITH REGULAR AND CASUAL PARTNERS EXPLAIN THE DIVERGING TRENDS IN HIV EPIDEMIC IN AUSTRALIA?

Sexual Health ◽

10.1071/shv4n4ab27 ◽

2007 ◽

Vol 4 (4) ◽

pp. 295

Author(s):

I. Zablotska ◽

G. Prestage ◽

A. Grulich ◽

J. Imrie ◽

S. Kippax

Keyword(s):

Gay Men ◽

Anal Intercourse ◽

Unprotected Anal Intercourse ◽

Unprotected Sex ◽

Cross Sectional ◽

Gay Community ◽

Hiv Epidemic ◽

Hiv Serostatus ◽

Policies And Programs ◽

Self Administered Questionnaire

Introduction: Worldwide, increases in unprotected anal intercourse have been linked to the resurgence in HIV and STI in gay men. We assessed whether changes in UAI within regular and casual relationships may explain the diverging trends in HIV in three Australian states - NSW, Victoria and Queensland. Methods: We used the data from the annual cross-sectional Gay Community Periodic Surveys conducted annually in Sydney since 1996 and in Melbourne and Queensland since 1998. A short self-administered questionnaire asks about HIV serostatus, sexual health testing and behaviours relevant to HIV epidemic. We present time trends in seroconcordance and unprotected sex with regular and casual partners. Results: Currently, about one third of gay men report being in monogamous regular relationships, and this proportion has been slowly increasing everywhere. The self-reported UAI with regular partners (UAIR) was highest among men in seroconcordant positive relationships, lower among seroconcordant negative partners and lowest in non seroconcordant relationships. From 1998 to 2006, the rates of UAIR consistently increased by 10% in all three states and in all relationships by serostatus. The rates of UAI with casual partners (UAIC) were historically highest in NSW. From a peak in 2001, UAIC rates have consistently declined in NSW, but continuing increases were observed in Victoria and Queensland. Higher rates of nondisclosure of HIV were also observed in the context of UAIC in the latter two states. Conclusion: Changes in unprotected sex with casual partners may be responsible for the slowing of HIV epidemic in NSW. Sustained investment in policies and programs are important in achieving behaviour change.

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Effective partnership and adequate investment underpin a successful response: key factors in dealing with HIV increases

Sexual Health ◽

10.1071/sh07078 ◽

2008 ◽

Vol 5 (2) ◽

pp. 193 ◽

Cited By ~ 25

Author(s):

Diana Bernard ◽

Susan Kippax ◽

Don Baxter

Keyword(s):

Hiv Prevention ◽

Social Research ◽

New South ◽

New South Wales ◽

Hiv And Aids ◽

Effective Response ◽

Financial Investment ◽

Gay Community ◽

South Wales ◽

Prevention Activities

Background: Australia has mounted an effective response to HIV and AIDS by investing in evidence-informed policy. Recently, in response to increases in HIV in some states in Australia, the New South Wales Department of Health set up a ‘think tank’ to examine differences in epidemiological and behavioural data, policies, strategies and community responses in order to account for state-based differences and ensure an effective ongoing response to HIV. Methods: The National Centre in HIV Social Research undertook key informant interviews with major stakeholders to help understand differences in responses by the three states most affected by HIV in Australia – Queensland, New South Wales and Victoria. In parallel, the Australian Federation of AIDS Organisations completed an analysis of the investments in HIV-prevention activities targeting gay men in all jurisdictions in Australia. The Australian Federation of AIDS Organisations also analysed the strategic contexts and government responses to HIV in the three states. Results: There were significant differences between New South Wales, Queensland and Victoria in the way the HIV partnership functions. Type of prevention strategy and level of financial investment in prevention activities appear to be related to the effectiveness of the ongoing response to HIV. Conclusions: An active commitment to and adequate resourcing of HIV prevention by all stakeholders in the HIV partnership – government and non-government departments, researchers and gay community organisations – is crucial if Australia is to respond effectively to HIV among gay and other men who have sex with men.

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