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.     

Sexual agreements between men in relationships

The range of sexual agreements among gay men regarding anal intercourse is explored. The article focuses on negotiated safety, and the results of a recent study on this type of agreement and its relation to risk behavior. When sexual partners engage in negotiated safety agreements, they usually do not practice unsafe sex. Successful negotiated safety agreements require reliable information regarding serostatus, as well as open and honest communication relating to the agreement. The advent of new treatments and the emergence of viral load testing potentially increase the complexity of negotiated agreements due to differing interpretations of HIV-seropositive status. Continuing research is needed to investigate what understandings gay men have regarding the new treatments, whether they incorporate these understandings into their agreements, and what happens to their sexual practice in this new context.     

A scale of optimism-scepticism in the context of HIV treatments

The aim of this research was to develop a brief scale of gay men's optimism-scepticism in the context of new HIV treatments. Following comprehensive literature search and communication with other researchers, 34 items about viral load testing, HIV therapies and concern about HIV infection were generated. By way of anonymous, self-complete questionnaires, these items were put to 532 gay men recruited at the Sydney Gay and Lesbian Mardi Gras Fair Day in February 1999. Principal axes factor analysis and item refinement yielded an optimism-scepticism scale based on 12 items (range 12-48, with higher scores indicating greater optimism). The sample mean was 19.8 (SD = 4.7). The scale had high internal consistency reliability (Cronbach's alpha = 0.79). Providing preliminary evidence of validity, men who reported unprotected anal intercourse with a causal partner 'in the past six months' had a significantly higher mean score (21.3) than those who did not report this risk practice (19.5, p < 0.001). Similar validation was provided from separate samples of gay men in Queensland and Sydney. Our scale of optimism-scepticism in the context of new HIV therapies is a brief, reliable instrument which can be incorporated within broader questionnaires and interview schedules. It is a useful tool to monitor attitudes toward HIV therapies and possible associations with risk practices.     

A study of HLA-A, B, DR and Bf bearing haplotypes derived from 304 families resident in the north west of England

We report here haplotype frequencies for class I (HLA-A, B), class II (HLA-DR) and class III (Bf) gene products of the major histocompatibility complex (MHC) of man. As in other studies (Bertrams & Baur, 1979; Grange et al., 1981), we have chosen to document all families typed for HLA antigens and Bf phenotypes irrespective of ascertainment. We obtained 1,094 haplotypes from 304 families resident in the North West of England, of which 34.1% had been fully typed for HLA-A,B,DR and Bf polymorphisms. We have been able to find both positive and negative linkage disequilibria for two and three locus haplotypes and have listed the most commonly occurring four locus haplotypes. Our data confirms the position of the complement group between HLA-B and HLA-DR, and we have looked for evidence of segregation distortion of MHC haplotypes.     

Patterns of Alcohol and Other Drug Use Associated with Major Depression Among Gay Men Attending General Practices in Australia

Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social, behavioural and AOD variables. Participants were classified into those with (n = 130) and without major depression (n = 401) using the PHQ-9 screening tool. Although rates of drug use were very high in the sample, multivariate logistic regression analysis showed that the majority of variables independently associated with major depression were social and behavioural factors. Only one AOD variable was associated with major depression: the use of three or more drug types in the past 6 months. Attending to specific patterns of AOD use may assist in the identification of gay men most at risk of major depression.     

A simple and rapid method for the detection of lymphocytotoxic antibodies using cell panels frozen on Terasaki plates

A 40 cell panel of lymphocytes selected for HLA-A,B and DR antigens, frozen in Terasaki microtest trays can be used routinely to identify the presence of specific HLA antibodies within two hours. Blind testing using well defined HLA typing sera showed that specificities could be identified to a high degree of significance using this method. The method has proved successful for screening for T cell, including HLA-A,B and B cell, including HLA-DR antibodies. The method is particularly useful for the routine tissue typing laboratory as the frozen panel can be used without the need for complicated and time-consuming cell washing procedures which have been the downfall of previously published methods.     

Cancer and Aboriginal people in Australia: A review of the literature

This paper provides a thematic review of the literature on cancer in Aboriginal people in Australia, focusing on experiences in diagnosis, treatment and care as well as addressing sociocultural factors to guide the public health response to poorer treatment outcomes. A search of both medical and social scientific databases for journal articles published between 1995 and 2006 show that cancer incidence and possibly survival and mortality data are likely to be underestimated in Aboriginal people. Aboriginal people are more likely to die from cancer than non-Aboriginal Australians. There are significant differences between the cancer experiences of those living in the city and in rural or remote areas. There is also a relative absence of literature on cancer in Aboriginal men, who are likely to have particular needs during diagnosis, treatment and care. In drawing conclusions from these data, it can be seen that Aboriginal people with cancer have poorer outcomes than non-Aboriginal Australians, and there is a need for further research in the patterns of care and predictors of outcomes in Aboriginal men and women with cancer. Particular attention should be given to the different needs and experiences of Aboriginal people in urban or rural/remote areas. These findings indicate an urgent need to allocate additional resources to the treatment and care of Aboriginal people with cancer, in addition to screening interventions. There is also a continuing need to acknowledge cultural differences in the health beliefs of Aboriginal people and to work in partnership with Aboriginal community controlled health organisations.