Gay men remain the primary population affected by HIV in Australia. While recent attention has been focused on increasing HIV testing and the use of antiretroviral-based prevention to reduce infections, it is equally important to sustain safe sex and other risk reduction practices. Increases in unprotected anal intercourse (UAI), for example, may counteract any beneficial changes in testing and treatment.
Methods: The Gay Community Periodic Surveys (GCPS) are repeated, cross-sectional surveys of men at gay events, venues and clinics in six Australian states and territories. National trends in key indicators for the period 2013-12 were analysed using logistic regression. The data were age standardized and weighted for recruitment venue prior to analysis. Results: Results from 70,214 participants were included. The majority were recruited from Sydney (34.5%), Melbourne (29.1%) and Queensland (20.6%) and from gay events (53.5%) and social venues (28.4%). Mean age in 2012 was 36.5 years (SD=12.4). Among the whole sample, the majority (>50%) continue to avoid UAI with any partner (this trend is stable over time) and the proportion of men reporting >10 partners in the last six months has declined significantly (from 29.5% in 2003 to 24.0% in 2012). Among men with regular partners, UAI has become significantly more common over time (45.9% to 49.9%). UAI has also become significantly more commonly reported by men with casual partners (31.6% to 38.3%). Among non-HIV-positive men, the proportion tested for HIV in the last year has remained stable (60.5% in 2012). The proportion of HIV-positive men on treatment has increased from 63.5% in 2003 to 77.9% in 2012.
Conclusion: While some behavioural trends among Australian gay men may be beneficial, significant rises in UAI by men with regular and casual partners (in the context of stable rates of HIV testing) pose a significant challenge to HIV prevention efforts.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
As part of the adult HIV and PPTCT (The Prevention of Parent to Child Transmission) services, Clinton Health Access Initiative, in collaboration with the Papua New Guinea Department of Health and Eastern Highlands Provincial Health Authority, implemented an HIV partner testing program in a public sector health center in Eastern Highlands Province in 2007. The program aimed to facilitate partner testing and disclosure in a safe environment, remove obstacles to care, involve partners in the promotion of infant HIV-free survival, increase early case detection and treatment among individuals at high-risk of HIV, and promote adherence antiretroviral treatment among PPTCT mothers.