Dean Murphy

In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex

Abstract The aim of this analysis was to examine gay mens sexual risk practice to determine patterns of risk managemtent. Ten cross-sectional surveys of gay men were condtrcted six-monthly from February 1996 to August 2000 at Sydney gay community social, sex-on-prmises and sexual health sites (average n=827). Evely February during this period, five identical surveys were conducted at the annual Gay and Lesbian Mardi Gras Fair Day (average n=11 78). Among the minority of men who had umprotected and intercourse which involved ejaculation inside with a serodiscordant regular partner, there was a clear pattern of sexual positioning. Few regular couples mere both receptive and insertive. Most HIV-positive men were receptive and insertive. Most HIV-positive men were recptive and most HIV-negative men were insertive. Among the minority of men who had unprotected anal intercourse which involved ejaculation inside with casual partners, there was also a patterns of sexual positioning. Whereas many casual couples were both receptive and insertive (especially those involviug HIV-positive respondents), among the remainder HIV-positive men tended to be receptive and HIV-negative men tended to be insertive. These pattenu of HIV-positive/receptive and HIV-negative/insertive suggest strategic risk reduction positionings rather tlran rrlere sexrial preferences among a minority of gay men. If so, they point they point to complacency but to an ever more cornplex domain of HIV prevention.

Fear appeals and treatment side-effects: An effective combination for HIV prevention?

Abstract Recent rises in the incidence of HIV infections among gay men in Australia have produced widespread discussion about appropriate health promotion responses. This has sometimes included calls for a return to fear-based campaigns, exemplified by the Grim Reaper advertisements in HIV. This paper discusses results from four focus groups that tested mock campaign material based on an appeal to fear. Five different poster images were tested among groups distinguished by age and HIV serostatus. Three posters used side-effects from treatments as the fear trigger and two used death from AIDS. A number of themes arose in response to the material including ‘othering’, shame and scepticism about HIV treatments. The meanings of these themes are explored in the light of current health-promotion theory. This data demonstrates that fear is an ineffective tool for HIV health promotion. It further demonstrates that feelings of shame and stigma are likely to be exacerbated in gay men, leading to poorer health outcomes in various ways.

The Desire for Parenthood Gay Men Choosing to Become Parents Through Surrogacy

Gay men are becoming increasingly involved in reproduction despite significant barriers limiting their access to reproductive technologies or legal parentage in many jurisdictions. Based on in-depth interviews with gay men in the United States and Australia who have become parents through surrogacy, I explore how gay men understand their desire to have children and what frames their parenthood experiences. The notion of choice is widespread in understandings of gay parenthood and family formation. Most of the men in this study did not develop a “procreative consciousness” as a result of sexual and fertility-related events. The majority also initially accepted the notion that homosexuality was synonymous with childlessness. Awareness of the possibilities for parenthood emerged over time through the promotional activities of surrogacy agencies, through media, peers, and relationship partners. Additionally, men played with the symbols of kinship to negotiate and obscure biogenetic paternity.

When do online sexual fantasies become reality? The contribution of erotic chatting via the Internet to sexual risk-taking in gay and other men who have sex with men

Seeking sexual partners online is associated with sexual risk-taking among men who have sex with men (MSM), but it is not well understood how this use of the Internet is implicated in potential sexual risks. The present study explores whether fantasizing about unprotected anal intercourse (UAI) during online chatting is associated with UAI with partners met online. An online survey of 2058 MSM in France included assessments of UAI with partners met online, responses to erotic chatting about UAI, intentions to use condoms, attitudes regarding UAI, practicing UAI with casual partners, alcohol and drug use with sex and biographical characteristics. While intentions to use condoms with casual partners were high, one-third (32.1%) of respondents reported UAI with partners met online. Responding positively to online chatting about UAI was significantly associated with UAI with partners met online, controlling for intentions, attitudes, behavior and biographic characteristics. These findings suggest that, while MSM may not go online to seek UAI, some engage in online fantasizing about UAI that is associated with possible sexual risk-taking. This speaks critically to the assumption that online fantasizing has no behavioral implications, and underscores the importance of human immunodeficiency virus prevention that addresses the dynamics of online chatting.

Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users

Objective: HIV preexposure prophylaxis (PrEP) decreases risk of HIV acquisition; however, its efficacy is closely dependent on adherence. There is also concern that the preventive effect of PrEP may be offset by risk compensation, notably an increase in condomless anal sex. Design: Multisite, open-label demonstration study that recruited people at current or recent risk of HIV infection in Melbourne, Australia. Methods: Participants were recruited from three general practice clinics and one sexual health clinic in Melbourne and consented to take daily tenofovir/emtricitabine (TFV/FTC) for 30 months. Sexual practice data, HIV and sexually transmitted infection (STI) test results were collected at baseline and 3-monthly during follow-up. PrEP adherence was evaluated by self-report at clinical visits, online surveys, refill-based assessments and dried blood spot testing. We present a 12-month interim analysis. Results: A total of 114 people were recruited. We observed a significant decline in condom use which occurred concomitantly with a significant increase in STIs over the first 12 months of PrEP. Incidence (per 100 person-years) of any STI was 43.2 and 119.8 at months 0–3 and 3–12, respectively [incidence rate ratio 2.77 (1.52, 5.56)]. Adherence to PrEP medication was high by all measures, including 6 month TFV/FTC levels in dried blood spot. Conclusion: We found a significant reduction in condom use and an increase in STIs over the first 12 months of follow-up. High medication adherence rates occurring with a decline in condom use and a rise in STIs, suggest that prevention, early detection and treatment of STIs is a chief research priority in the current era of HIV PrEP.OBJECTIVE HIV Pre-exposure prophylaxis (PrEP) decreases risk of HIV acquisition however its efficacy is closely dependent on adherence. There is also concern that the preventive effect of PrEP may be offset by risk compensation, notably an increase in condomless anal sex. DESIGN Multi-site, open-label demonstration study that recruited people at current or recent risk of HIV infection in Melbourne, Australia. METHODS Participants were recruited from three general practice clinics and one sexual health clinic in Melbourne and consented to take daily tenofovir/emtricitabine for 30 months. Sexual practice data, HIV and sexually transmitted infection (STI) test results were collected at baseline and 3-monthly during follow up. PrEP adherence was evaluated by self-report at clinical visits, online surveys, refill-based assessments and dried blood spot (DBS) testing. We present a 12-month interim analysis. RESULTS 114 people were recruited. We observed a significant decline in condom use which occurred concomitantly with a significant increase in STIs over the first 12 months of PrEP. Incidence (per 100PY) of any STI was 43.2 and 119.8 at m0-3 and M3-12, respectively (IRR 2.77 (1.52, 5.56)). Adherence to PrEP medication was high by all measures, including six month TDF-FTC levels in DBS. CONCLUSIONS We found significant reduction in condom use and an increase STIs over the first 12 months of follow-up. High medication adherence rates coupled with a decline in condom use and a rise in STIs, suggests that prevention, early detection and treatment of STIs is a chief research priority in the current era of HIV PrEP.

Scaling HIV vaccine attitudes among gay men in Sydney, Australia.

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 alpha = 0.81; II, Confidence in HIV Vaccines/Vaccine Trials, Cronbach alpha = 0.71; III, Sexual Freedom, Cronbach alpha = 0.64; IV, Willingness to Participate in HIV Vaccine Trials, Cronbach alpha = 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.

The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men

There are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. For gay men, drug and alcohol use can be a creative or experimental response to social marginalisation - and not necessarily a problematic one in every instance. Numerous studies have found that infection with HIV and other sexually transmissible infections (STIs) is more likely among gay and men who have sex with men (MSM) who use recreational drugs than those who do not, but the causal nature of these relations is uncertain. Sexualised drug use is associated with a range of other problems, including dependence, mental health issues, accident and overdose. A growing body of work in the Alcohol and Other Drugs (AOD) field demonstrates the action of drugs and their purported effects to be a product of their relations with various other actors, contexts and practices. Given these contingencies, it is impossible to predict the future of drugs or their effect on the sexual health of gay and MSM with any degree of certainty. This article outlines some of the conditions most likely to mediate such futures in the medium term. Public funding for lesbian, gay, bisexual, transgender and queer drug issues should not remain restricted to questions of HIV prevention and sexual health. It should be expanded to equip sexual health and AOD service providers with the cultural and sexual literacy to mitigate stigma and allow them to respond constructively to drug problems among sexual and gender minorities as a matter of priority.

Willingness to use HIV pre-exposure prophylaxis has declined among Australian gay and bisexual men: Results from repeated national surveys, 2011-2013

Abstract:We surveyed willingness to use pre-exposure prophylaxis (PrEP) and the likelihood of decreased condom use among Australian gay and bisexual men in 2011 and 2013 (n = 2384). Willingness to use PrEP declined from 28.2% to 23.3% [adjusted odds ratio = 0.83, 95% confidence interval (CI): 0.68 to 1.00, P = 0.050]. Willingness to use PrEP was the greatest among men with HIV-positive partners and among those who had taken HIV postexposure prophylaxis. Among men willing to use PrEP, the likelihood of decreased condom use remained stable between 2011 and 2013 (8.0% vs. 11.9%; adjusted odds ratio = 1.40, 95% CI: 0.80 to 2.45, P = 0.23). A minority of men remain willing to use PrEP and appear to be appropriate candidates for it.

Risk management and harm reduction among gay men in Sydney

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 time, the evidence presented here confirms the role of a number of other harm-reduction strategies, some safer than others. The challenge now for educators, both locally and elsewhere, is how to sustain safe sex and where appropriate build harm reduction into gay mens health education in the face of diverse and ever-changing gay communities. Recent rises in HIV infections have increased uncertainty and serve as a timely reminder that there are no easy solutions to what remain complex and difficult-to-grasp phenomena.

Willingness to use and have sex with men taking HIV pre-exposure prophylaxis (PrEP): results of online surveys of Australian gay and bisexual men, 2011-2015.

Objective Assess willingness to use HIV pre-exposure prophylaxis (PrEP), support for others using it and willingness to have sex with partners using PrEP among Australian gay and bisexual men (GBM). Methods National, online cross-sectional surveys of Australian GBM were conducted in 2011, 2013 and 2015. Scales measuring support for and willingness to have sex with men using PrEP were developed in 2015 using factor analysis. Trends and associations with key measures were analysed using multivariate logistic regression. Results During 2011–2015, 3850 surveys were completed by GBM. Willingness to use PrEP among HIV-negative and untested men did not change between 2011 (28.2%) and 2015 (31.7%, p=0.13). In 2015, willingness to use PrEP was independently associated with younger age, having an HIV-positive regular partner, recent condomless anal intercourse with casual male partners (CAIC), more than 10 male sex partners in the previous 6 months, ever having taken postexposure prophylaxis and having fewer concerns about using PrEP. In 2015, 54.5% of GBM supported other GBM taking PrEP and 39% were willing to have sex with men using PrEP. Support for and willingness to have sex with PrEP users were both associated with being HIV-positive, having a university degree and having two or more male partners in the previous 6 months. Willingness to have sex with men on PrEP was also associated with recent CAIC and using party drugs for sex, but was less likely among men who consistently used or had a positive experience using condoms. Discussion Interest in and support for using PrEP are concentrated among men who engage in higher risk practices and who know more about living with HIV. This is consistent with the targeting of PrEP in Australia.