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.
Methods: TAXI-KAB was a national online survey of Australian gay men recruited during late 2012. Men were asked about sexual behavior, last HIV test and barriers to testing in the past 12 months. We focused on men who reported UAIC, and used chi-squared tests to see if barriers varied according to whether men had tested more than or less than 2 years ago (“distant testers” and “recent testers” respectively).
Results: Of 771 men recruited, 269 (34.9%) reported UAIC in the past 6 months. Among men reporting UAIC testing barriers were often higher among distant testers: ‘the process of getting tested is too much hassle’ (50% in distant testers vs 23% in recent testers, p=0.012), ‘I haven’t had any symptoms or illness that made me worry’ (48% vs 17%, p=0.003) and ‘I don’t want to have to discuss my sex life’ (41% vs 11%, p<0.001). Distant testers indicated they did not appreciate ‘having to return for a result’ (47% in distant testers vs 27% in recent testers, p=0.08). Length of time since being tested was not associated with: ‘I haven’t done anything risky’ (22% vs 15%, p=0.393) nor ‘I don’t want to know the result’ (25% vs 22%, p=0.816).
Conclusion: Structural and other barriers to HIV testing are important for men who engage in UAIC and appear more influential in distant testers. These results highlight the importance of convenient ways to access testing. Empowering men to assess their own risks and need for testing without detailed pre-test discussions may encourage testing for some men.
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.
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.
Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.
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.