Under the Covers and Between the Lines

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Information about Under the Covers and Between the Lines
Health & Medicine

Published on October 24, 2014

Author: AFAO

Source: slideshare.net


AFAO is currently undertaking a project to examine existing Australian and international social and behavioural research on gay men’s sexual and social behaviour from an HIV health promotion perspective, and to identify gaps in research and health practitioners’ knowledge that could be explored through additional research.

This presentation provides an overview of the development of the report to date, including a summary of some specific sections of the report.

This presentation was given by Dr Dean Murphy, AFAO HIV Education Officer, at the AFAO National HIV Forum, 17 October 2014.

1. Under the Covers and Between the Lines: Better understanding Australian gay men’s behaviour and HIV risk Dean Murphy AFAO National Forum 17 October 2014

2. Overview  Background and aims  Areas/topics covered by the report  Questions that have framed the writing in each area  Example of report chapter

3. Background  In 2013 MSM comprised 71% of all new HIV diagnoses (and 67% of new diagnoses in 2009–2013 period)  Annual Surveillance Report and Annual Report on Trends in Behaviour  Focus  Interpretation of ASR and ARTB  Summary of research findings and trends within this population  Identify areas where additional research and/or analyses could provide important information to guide HIV health promotion

4. Aims  To increase capacity to assess, prioritise and integrate research findings into program design and delivery  To identify gaps in current knowledge in social, behavioural and epidemiological research  New research projects  Existing data sets  To develop greater expertise in the HIV community sector in understanding what kinds of questions can be investigated through different study designs

5. Sections  Introduction / background  Youth / same-sex attraction / coming out  Meeting sexual partners: where, when, how?  HIV testing  Preventing HIV: condoms, risk reduction strategies  Preventing HIV: ARV-based prevention approaches  Negotiating relationships  Living with HIV / experiences of HIV diagnosis / uptake of ARV therapy  Drugs & alcohol  Psychosocial issues

6. Questions framing the report  For each of these chapters we used a set of questions to frame the writing:  Why this is an important area / what will be covered in this section  What’s changed / what’s changing / what has stayed the same  Health promotion and policy implications / What we need to do  Do we have a ‘position’ on this?  What we need to know more about / Recommendations for more research or analyses

7. Preventing HIV: ARV-based approaches  Since 2010, evidence of the efficacy of PrEP, TasP  Trials of microbicides, including rectal microbicides  PrEP is available in limited way through demonstration projects – and some people also accessing ARVs for PrEP in other ways  Policy shifts: lifting of CD4 limit on initiation of ARV therapy; and prevention of transmission to sexual partners as consideration for recommending ARV therapy  National Strategy: ‘We need to establish a greater level of knowledge of new prevention and treatment options, including treatment as prevention’  Ethical considerations  Cost effectiveness

8. What’s changed / same / new?  Low confidence in the effectiveness of TasP  only 2.6% of men agreed that HIV treatment prevented transmission (but HIV-positive men were three times more likely to agree than HIV-negative men)  Little change from 2011 to 2013  Also, HIV-negative men report lower acceptability of TasP as a prevention strategy  High level willingness and motivation to use PrEP among a minority of men  Willingness concentrated men at higher risk for HIV (36% vs. 19%)  Decrease from 2011 to 2013  Small number of men (<2.5%) report PrEP use  Majority of men report a favourable attitude to PrEP but only a minority indicate a likelihood/intention to use it in near future  Knowledge of PrEP trials results low – 62% unaware of any research evidence  Interest in using rectal microbicides  Approx. one-fifth of non-positive men report strong interest in using RM

9. What’s changed / same / new? (cont.)  High usage of post-exposure prophylaxis (PEP)  over 3% of gay men report having used PEP in previous 6 months (13–15% gay men ever used PEP)  Only approx. 60% of men are aware of PEP  Among men recently diagnosed HIV positive, PEP awareness was even lower  Previous use of PEP is associated with more positive attitudes to PrEP, TasP & RM  Attitudes of people who work in HIV sector to different ARV-based prevention strategies  Hierarchy of beliefs about effectiveness

10. Health promotion implications / What we need to do  Increase awareness of ARV-based prevention, especially TasP  Shift away from individual vs. public health framing of ARV therapy  Promote discussion of PrEP  Framing of PrEP – possibilities/opportunities: what it enables (active interest in prevention; serodiscordant relationships; regular HIV/STI testing; release from fear, anxiety, shame, guilt)  Importance of adherence, monitoring, for people taking PrEP outside demonstration projects  ‘PrEP + neg’ as new identity category  Frequent PEP users – PrEP as alternative  Starting/stopping PrEP safely

11. What we need to know more about?  Knowledge about PrEP, RM, TasP  Experiences of PrEP  What PrEP is  Cost-effectiveness  NY study – PrEP will need high adherence, high effectiveness, and high coverage in specific populations to be affordable

12. Report timeline  Production finalised late November  Released December

13. Thank you

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