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.     

Willingness to participate in future HIV prevention trials in Beira,Mozambique

We conducted an evaluation of healthcare accessibility among patients taking antiretroviral treatment (ART) after they were ‘down-referred’ from hospital-based programmes to primary healthcare (PHC) centres in a rural South African setting. A cross-sectional design was used to study 109 PHC users compared to a randomly selected control group of 220 hospital-based users. Both groups were matched for a minimum duration on ART of six months. Using a comprehensive healthcare-accessibility framework, the participants were asked about availability, affordability and acceptability of their ART care in structured exit interviews that were linked to their ART-clinic record reviews. Unadjusted and adjusted regression models were used. Down-referral was associated with reduced transportation and meal costs (p = 0.001) and travel time to an ART facility (p =0.043). The down-referred users were less likely to complain of long queues (adjusted odds ratio [AOR] 0.06; 95% confidence interval [95% CI]: 0.01–0.29), were more likely to feel respected by health providers (AOR 4.43; 95% CI: 1.07–18.02), perceived lower stigma (AOR 0.25; 95% CI: 0.07–0.91), and showed a higher level of ART adherence (AOR 8.71; 95% CI: 1.16–65.22) than the hospital-based users. However, the down-referred users preferred to consult with doctors rather than nurses (AOR 3.43; 95% CI: 1.22–9.55) and they were more likely to visit private physicians (AOR 7.09; 95% CI: 3.86–13.04) and practice self-care (AOR 4.91; 95% CI: 2.37–10.17), resulting in increased health-related expenditure (p = 0.001). Therefore, the results indicate both gains and losses in ART care for the patients, and suggest that down-referred patients save time and money, feel more respected, perceive lower stigma and show better adherence levels. However, unintended consequences include increased costs of using private physicians and self-care, highlighting the need to further promote the potential gains of down-referral interventions in resource-poor settings.     

Willingness to participate in preventive HIV vaccine trials in a community-based cohort in south western Uganda

Objectives  To assess willingness to participate in HIV vaccine trials and possible barriers to participation.
Methods  Questionnaire survey of participants completing a 2-year community-based HIV Vaccine Preparedness Study, followed by cross sectional analysis of data.
Results  95% of participants were willing to participate in a trial with similar attributes to the Vaccine Preparedness Study. Certain hypothetical trial attributes significantly reduced willingness to participate: The requirement to delay pregnancy (for females) had the largest effect, reducing willingness to participate from 97% to 23% ( P  < 0.0001). Larger blood draws had the second largest effect: 95–55% ( P  < 0.0001). The possibility of receiving either candidate vaccine or placebo had the third largest effect: 95–73% ( P  < 0.0001). Monthly study visits had the fourth largest effect: 95–92% ( P  < 0.0001). Trial duration longer than 2 years had the least effect: 95–93% ( P  = 0.0025). Combined attributes reduced willingness to participate from 95% to 43% (McNemar's χ² = 521.00; P  < 0.0001) overall and 97–11% (McNemar's χ² = 531.00; P  < 0.0001) for female participants. Physical harm concerns (adjusted OR = 34.9; 95% CI, 10.4–118) and a low risk behaviour index (adjusted OR = 0.09; 95% CI, 0.01–0.73) were associated with unwillingness to participate.
Conclusions  We found a high level of willingness to participate in HIV vaccine trials in this population. However, certain HIV vaccine trial requirements were associated with reduced willingness to participate. Community as well as individual concerns will have to be carefully addressed in planned HIV vaccine trials.     

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

The study objective was to assess willingness of men who have sex with men (MSM) enrolled in a vaccine preparedness study ('Projeto Rio') to participate in phase III anti-HIV/AIDS vaccine trials. Overall, 57% of Projeto Rio participants stated they would participate in a putative vaccine trial. MSM who reported commercial sex work were significantly (p < 0.05) more likely to engage in risky behaviours than others. In bivariate analysis, commercial sex workers (CSWs) were significantly (p < 0.05) more likely than non-commercial sex workers (NCSWs) to be willing to participate in vaccine trials (62.6% versus 51.4%). Among those willing, CSWs reported significantly more often (p < 0.05) (50.5%) than NCSWs (38.0%) that they would enroll to protect themselves from HIV. In multivariate analyses, variables associated with willingness to participate (WTP) were lower educational level, positive serology for syphilis, and 'engagement, under the influence of alcohol, in risky sexual practices that would normally be avoided', but not commercial sex work. The potential enrollment in vaccine trials of MSM CWSs, as well as participants of low socio-economic status and high risk, seems thus to be possible.     

Improvements in sexual health testing among gay men in Sydney, Australia, 2003-2007

In order to be effective, sexually transmitted infection (STI) testing should be comprehensive based on the clients' sexuality and risk practices. Using data from the Sydney Gay Community Periodic Survey, we explored trends in and factors associated with STI testing among gay men during 2003-2007. Among men who were not HIV-positive, 68% were tested for HIV in 2007. HIV testing was more common than STI testing and remained stable during 2003-2007. Use of swabs and urine samples increased significantly (P-trend<0.001 for each). However, until 2007, 33% of men were not tested. Sexual behaviours (higher number of partners, having casual partners and engaging in unprotected anal intercourse with them) were associated with STI testing. HIV-negative men were tested for STI less often than HIV-positive men (prevalence ratio=0.56; 95% CI: 0.47-0.68). STI testing among HIV-negative men has improved significantly but remains inadequate for STI control and HIV prevention. It should not be assumed that appropriate and comprehensive STI screening is always provided to clients.     

"Serosorting" in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia

This paper addresses the question of whether HIV-negative gay men engage in "serosorting" in casual encounters. Serosorting, defined as engaging in unprotected anal intercourse with casual partners who they report to be HIV negative, has been increasing among HIV-negative gay men in Sydney. Prevention and intervention programmes are urgently needed to alert HIV-negative gay men to the risks associated with "serosorting", and remind them of the need for consistent condom use.     

Willingness to participate in cardiac trials

The elderly, women, and minorities are all less likely to be enrolled in randomized clinical trials (RCTs). Whether differential patient interest in RCTs contributes to these disparities is unclear. The authors surveyed 660 patients' willingness to consider two potential cardiac RCTs of medical therapy vs. percutaneous coronary angioplasty or coronary artery bypass surgery, respectively. The cohort's mean age was 67 years (43% aged ≥70 years; 35% women; and 28% nonwhite). Compared with younger patients, those aged ≥70 years were equal or more likely to consider both the percutaneous coronary angioplasty (46% vs. 41%) and coronary artery bypass surgery RCTs (35% vs. 31%). Race also had no significant impact on trial enrollment, yet women were significantly less likely than men to participate in either RCT. In conclusion, patient willingness to consider RCT participation does not explain underenrollment of elderly and minority patients. Women, however, were more reluctant to consider RCTs, an area requiring further study.     

Contexts for last occasions of unprotected anal intercourse among HIV-negative gay men in Sydney: the health in men cohort

The objective of the paper was to compare encounters involving unprotected anal intercourse (UAI) and protected anal intercourse (PAI) among HIV-negative gay men in Sydney. Data were from those completing baseline face-to-face interviews to end June 2003 for the Health in Men open cohort of HIV-negative gay men in Sydney. The 1,148 participants ranged in age from 18 to 75 years (median = 36). Three hundred and fifty-two (30.7%) reported an occasion of UAI with a casual partner in the previous 6 months and 531 (46.3%) reported an occasion of UAI with a regular partner in that same time. The men's most recent sexual contact with a casual partner involving UAI was distinguished from those involving PAI by a greater likelihood for both partners to disclose HIV serostatus (p = 0.006) and by respondents being more inclined to restrict themselves to the insertive position or to practise withdrawal during occasions involving any UAI than when a condom was used (p = 0.003 and p = 0.001 respectively). Neither location nor recreational drug use differentiated men's most recent sexual contacts involving UAI from those involving PAI. The decision by HIV-negative gay men to use condoms during sexual encounters with either regular or casual partners is guided more by HIV serostatus and risk reduction strategies than by other factors.     

HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne

OBJECTIVES: To investigate associations between gay men's optimism and sexual behaviour in the context of new HIV treatments. METHODS: Cross-sectional surveys (using anonymous, self-completed questionnaires) were conducted in Sydney during February 1998 (n = 2200) and in Melbourne during January 1998 (n = 1891). Gay men were recruited at social and sex-on-premises venues, clinics and fair days/carnivals. RESULTS: In a multivariate analysis, unprotected anal intercourse with casual partners (UAIC) was associated with being recruited at a sex-on-premises venue (rather than a clinic or fair day/carnival), HIV positivity, having been tested for HIV less than 6 months ago (rather than over 2 years ago or never having been tested), and not having a regular partner. Over and above these factors, UAIC was associated with agreement with the statements 'An HIV-positive person who is on combination therapy is unlikely to transmit HIV' and 'I'm less worried about HIV infection than I used to be'. CONCLUSIONS: The data reveal a significant relationship between UAIC and certain aspects of optimism in the context of new HIV treatments. Whereas the direction of causality cannot be specified, there is a clear need for HIV and sexual health education programmes to clarify issues of viral load, new and drug resistant strains of HIV, and other infectious agents.     

Attitudes towards new HIV biomedical prevention technologies among a cohort of HIV‐negative gay men in Sydney,Australia

Objectives

The aim of the study was to explore the awareness of rectal microbicides, the use of pre‐exposure prophylaxis (PREP) and the willingness to participate in biomedical HIV prevention trials in a cohort of HIV‐negative gay men.

Methods

In a community‐based cohort study, HIV‐negative homosexually active men in Sydney, Australia were questioned about awareness of rectal microbicides, use of PREP, and willingness to participate in trials of such products. Predictors of awareness and willingness to participate were analysed by logistic regression. Use of PREP was examined prospectively.

Results

Overall, 14% had heard of rectal microbicides. Older (P=0.05) and university‐educated men (P=0.001) were more likely to have knowledge of rectal microbicides. Almost one‐quarter (24%) of men reported that they were likely/very likely to participate in rectal microbicide trials. Among those men with definite opinions on participation, awareness of rectal microbicides was significantly associated with unwillingness to participate [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.65–0.93, P=0.007]. Willingness to participate in trials using antiretroviral drugs (ARVs) to prevent HIV infection was reported by 43% of men, and was higher among those who reported unprotected anal intercourse (UAI) with HIV‐positive partners (OR 1.88, 95% CI 0.99–3.56). There was no evidence of current PREP use.

Conclusions

This study demonstrates that Australian gay men have had little experience with PREP use and rectal microbicides. About half would be willing to consider participation in trials using ARVs to prevent HIV infection. Extensive community education and consultation would be required before PREP or rectal microbicides could be trialled in populations of gay Australian men.

     

Sex work and risk behaviour among HIV-negative gay men

Gay men who engage in sex work may be at increased risk through risk behaviour outside the context of sex work. Among participants in the Health in Men (HIM) cohort of HIV-seronegative gay men in Sydney, 19.7% had ever engaged in sex work. Five percent reported being paid for sex in a six-month period during the study (2001-2006); a minority (18.3%) of these current sex workers reported unprotected anal intercourse (UAI) with clients and 62.0% reported UAI with any casual partners. The practice of sex work itself may not represent increased risk for HIV transmission but sex workers in this study were, nonetheless, at markedly increased risk in other aspects of their lives.     

Willingness to participate in HIV vaccine research in a peri-urban South African community

Research on willingness to participate in HIV vaccine trials is important in preparations for HIV vaccine research, but there are few data from sub-Saharan Africa. We interviewed 198 individuals in a peri-urban South African community immediately after enrolment into an HIV vaccine preparedness study on their willingness to participate in hypothetical vaccine trials. Overall 23% of participants (n = 46) said that they would be willing to participate in an HIV vaccine trial. Willingness was associated with increasing age, male gender, and increasing knowledge about vaccines generally and HIV vaccines specifically. In multivariate analysis, a 1-unit increase in HIV vaccine knowledge score was associated with a 10-fold increase in willingness to participate (adjusted odds ratio, 10.72, 95% confidence intervals: 4.40-26.12). These results suggest that while willingness to participate in HIV vaccine trials is relatively low in this setting, educational campaigns may have a substantial impact on individuals' willingness to participate in research.     

Increasing realism among gay men in Sydney about HIV treatments: changes in attitudes over time

It is important to know if optimism about HIV treatments is widespread and whether it is growing. To this end, cross-sectional surveys of gay men were conducted 6-monthly in Sydney between February 1997 and February 1999 (n = 3012). Recruitment was consistent at 4 gay community venues. The participants responded True, False or Unsure to 5 statements about the effectiveness of HIV treatments (2 items), and transmission (2 items) and 'worry' (1 item) in the context of treatments. In terms of effectiveness, HIV-positive men were more likely than non-positive men to dismiss 'cure' (P < 0.05) and more likely to support 'treatments prevent serious illness' (P < 0.001). Uncertainty about effectiveness decreased over time (P < 0.001 for each item). In terms of transmission, HIV-positive men were more likely than non-positive men to reject notions of reduced infectivity (P < 0.001). Over time, there was less uncertainty among non-positive men about undetectable viral load and transmission possibilities (P < 0.001). Overall, HIV-positive men were less 'worried' than non-positive men (P < 0.001) but there were no changes over time. On the whole, gay men in Sydney are now less uncertain about highly active antiretroviral therapies (HAART) than at the time of their introduction. Most men remain sceptical that these treatments can cure HIV infection and prevent HIV transmission, but in regard to managing illness among those infected, some initial uncertainty is being replaced by a growing optimism about the efficacy of treatments.     

HIV transmission among gay men through oral sex and other uncommon routes: case series of HIV seroconverters, Sydney

Seventy-five homosexual men with recently acquired HIV were interviewed about their risk behaviour. Fifty-nine reported unprotected anal intercourse, and one shared injecting equipment, with a partner not known to be HIV negative. Of the remaining 15, 11 reported protected anal intercourse. In five of the 15 we judged oral sex to be the most likely source of infection, including three men who had a genital piercing. The possible transmission risk from genital piercing should be investigated.     

Prevalence of enteric protozoa in human immunodeficiency virus (HIV)-positive and HIV-negative men who have sex with men from Sydney, Australia

A prospective, comparative study of the prevalence of enteric protozoa was determined among human immunodeficiency virus (HIV)- positive and HIV-negative men who have sex with men (MSM) in Sydney, Australia. A total of 1,868 patients submitted stool specimens; 1,246 were from MSM (628 HIV positive and 618 HIV positive) and 622 from non-MSM were examined over a 36-month period. A total of 651 (52.2%) stool specimens from MSM were positive for protozoa compared with 85 (13%) from non-MSM. There was a significant difference in the prevalence of Blastocystis hominis, Endolimax nana, Entamoeba histolytica/dispar complex, Entamoeba hartmanni, Iodamoeba butschlii, and Enteromonas hominis detected between MSM and non-MSM (P<0.001). The only notable difference between HIV-negative and HIV-positive MSM was that HIV-infected MSM were found to more likely have a Cryptosporidium parvum infection. Entamoeba histolytica was found in 3 patients, E. dispar in 25, and E. moshkovskii in 17, all of whom were MSM. When compared with a control group, MSM were significantly more likely to harbor intestinal protozoa and have multiple parasites present. The results of this study show high rates of enteric parasites persist in MSM and highlight the importance of testing for intestinal parasites in MSM. This is the first report of E. moshkovskii from MSM.     

HIV risk-taking behaviour among amphetamine users in Sydney, Australia

A survey was undertaken of needle-sharing and sexually risky behaviour among 231 Australian amphetamine users, half of whom usually injected amphetamine. The prevalence of risky needle use and sexual behaviour was similar to that observed in recent Australian surveys of opioid injectors. About a third of those who had ever injected had shared needles, and the variables that best predicted frequency of sharing needles were having an injecting drug user as a partner, having experienced symptoms of dependence on amphetamines, and having sought medical treatment for an amphetamine related problem. Regular condom use with either regular or casual partners toas low; only the minority employed in the sex industry regularly used condoms. Sexual risk-taking was not related to needle-sharing or amphetamine use. Although Australian amphetamine and opioid users have reduced their risks of transmitting HIV, there remains a substantial minority of both types of drug injector who continue to place themselves and others at risk by sharing needles and engaging in unsafe sexual behaviour.