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Background Regular sexual partnerships among gay and bisexual men (GBM) who practice condomless anal intercourse (CLAI) have not been well characterised in terms of partnership type, HIV seroconcordance and risk of HIV transmission. Primarily sexual regular partnerships, although commonly reported by gay men, have largely been ignored in research and HIV prevention. Among regular partners reporting CLAI with each other, we determined factors differentiating romantic or committed relationships from partnerships organised primarily around sex ('fuckbuddies') and estimated the proportion of CLAI presenting risk for HIV transmission., Methods: An online, cross-sectional survey of Australian GBM was conducted. Univariate and multivariate generalised estimating equations were used to determine statistical associations., Results: Men reported on 2250 regular sexual partnerships. Over half the partnerships were romantic or committed relationships. Over half the partnerships were HIV-negative seroconcordant (54.9%), 3.1% were HIV-positive seroconcordant, 5.2% were serodiscordant and 36.8% were of unknown seroconcordance. Potential risks presented by CLAI were sometimes mitigated by protective factors, such as having a clear spoken agreement about sex with outside partners, having fewer outside partners, openly discussing HIV risk and having an agreement to reduce risk from outside partners. These protective factors were more often found in romantic or committed relationships than among primarily sexual partnerships, and were less often found in partnerships of unknown seroconcordance., Conclusion: CLAI is more common among regular sexual partnerships considered to be of a romantic, committed nature. However, factors associated with such romantic or committed partnerships can also protect against HIV transmission risk. Unknown seroconcordance, particularly lack of communication about HIV status among primarily sexual partnerships, is a key risk factor that needs to be addressed by HIV education.

Rapid developments in the field of HIV pre-exposure prophylaxis (PrEP) with antiretrovirals offer a promise to bring HIV transmission among gay and other men who have sex with men (MSM) to zero by 2030. This review evaluates studies, which modelled the impact of PrEP on HIV diagnoses, and discusses the progress towards PrEP implementation. Studies in English, conducted after 2010 among MSM in countries of the Organization for Economic Cooperation and Development (OECD) were reviewed. Six modelling studies were included, three of which had been conducted outside the US. None of the published models showed that PrEP alone can reduce HIV diagnoses to zero and eliminate HIV transmission by 2030. However, PrEP in combination with other biomedical interventions can reduce HIV diagnoses on the population level by ~95%. Other upcoming biomedical prevention strategies may strengthen combination prevention. Access to PrEP remains limited, even in the OECD countries. Modelling studies can assist governments with decision-making about PrEP implementation and add urgency to the implementation of PrEP. More work is needed on modelling of the impact of PrEP on HIV diagnoses trends outside the US where PrEP implementation is in its early stages.

This editorial to the special issue of Sexual Health on antiretroviral-based prevention of HIV infection is dedicated to showcasing research and practice in this area. It aims to promote debate regarding the potential of new antiretroviral-based prevention approaches and the challenges encountered in moving prevention innovations into the community. This special issue covers the breadth of innovative HIV prevention research, including that undertaken in the fields of epidemiology, clinical research, social and behavioural science, public health and policy analysis, and with special emphasis on Asia and the Pacific region. Most importantly, it provides an indication of how the region is progressing towards embracing new prevention approaches to combat HIV epidemics across the region.

Background: The Australian HIV and sexually transmissible infection (STI) behavioural surveillance system (the repeated cross-sectional Gay Community Periodic Surveys, GCPS) has been conducted since 1998 and covers six main Australian jurisdictions. In this paper, we review its history and methodology, and the available indicators, their trends and their use., Methods: We describe the design and history of GCPS. For analyses of indicators, we use Pearson's χ²-test and test for trend where appropriate., Results: About 90% of gay men in Australia have been tested for HIV (60% to 70% of men who were not HIV-positive) have been tested as recommended in the preceding 12 months. STI testing levels (≈ 70% in the preceding 12 months) are high, but remain insufficient for STI prevention. In general, unprotected anal intercourse with regular (UAIR) and casual (UAIC) sex partners has increased over time. The prevalence and increasing trends in UAIR were similar across jurisdictions (P-trend <0.01), while trends in UAIC differed across the states: during 2001-08, UAIC declined in NSW (P-trend <0.01) and increased elsewhere (P-trend <0.01). Trends in UAIC were associated with HIV diagnoses., Conclusion: This review of the design, implementation and findings of the Australian HIV/STI behavioural surveillance highlights important lessons for HIV/STI behavioural surveillance among homosexual men, particularly the need for consistent data collection over time and across jurisdictions. Investment in systematic behavioural surveillance appears to result in a better understanding of the HIV epidemic, the availability of a warning system and a better targeted HIV prevention strategy.

Objectives: We examined whether trends in HIV testing in community-based samples of homosexual men may account for the convergence in HIV notification rates in homosexual men across the eastern states of Australia., Methods: We examined data on self-reported HIV testing from annual cross-sectional, self-completed anonymous surveys of homosexual men conducted between 1998 and 2006 in Sydney, Melbourne and Brisbane. Men were recruited at gay community venues and events. Comparisons of HIV testing between the three cities and across time were carried out. We also compared reported rates of HIV testing across states in Private Lives, the 2005 online survey of health and wellbeing among non-heterosexual people., Results: Men recruited from clinics had a much higher prevalence of HIV testing and were excluded from further analyses. Among the 48 263 completed questionnaires obtained in non-clinic sites, there was a marked decline in the proportion of men who had never been tested for HIV in Sydney (from 8.1 to 5.1%, P trend < 0.001) and Brisbane (from 11.8 to 7.9%, P trend = 0.002) but no change in Melbourne. This proportion of men who had never been tested was lower in Sydney than in either Melbourne or Brisbane (P < 0.001). There were increases in the proportion of non-HIV-positive men who had been tested for HIV in the previous year across all three cities, although the proportion in Melbourne was lower than in the other two cities., Conclusion: These data suggest that changes in HIV testing rates among homosexual men are insufficient to account for the recent differences in trends in HIV notifications in eastern Australia.

Background: In Australia, the HIV epidemic is concentrated among gay men. In recent years, the number of new diagnoses stabilised in New South Wales (NSW), but increased in other states. We reviewed the trends in sexual behaviours to explain this difference., Methods: We used the Gay Community Periodic Surveys in NSW, Victoria and Queensland during 1998-2006 and restricted analyses to the 30-49 year olds who contribute most of the HIV cases. We used the chi(2)-test for trends in unprotected anal intercourse with casual partners (UAIC) and regular partners, number of partners, type of relationships, knowledge of HIV serostatus and its disclosure. We compared behaviours of HIV-positive and -negative men and men across states using logistic regression adjusted for the year of report., Results: Trends in behaviours differed across the states: following a period of increase, UAIC prevalence declined in NSW since 2001, but continued to increase in Victoria and Queensland. There were other changes in NSW that were not observed in Victoria and Queensland: a decline in factors increasing HIV risk (the proportions of men with multiple sex partners and men engaging in UAIC and not knowing or not disclosing HIV serostatus) and an increase in behaviours reducing it (the proportions of men in monogamous relationships and men disclosing HIV serostatus while having UAIC)., Conclusion: There were patterns of declining HIV risk behaviours in NSW, and increasing risk behaviours elsewhere, that mirrored recent changes in HIV case notifications in Australia. These data suggest that behavioural surveillance can predict changes in HIV epidemiology.