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Generational change is believed to be transforming the educational and employment preferences of medical trainees. In this article, we examine generational tensions in interviews with policy leaders and clinicians on workforce issues within one subset of the Australian medical profession: general practitioners who provide care to people with HIV in community settings. Integrating the accounts of policy leaders (n = 24) and clinicians representing the ‘first generation’ (n = 21) and ‘next generation’ (n = 23) of clinicians to do this work, shared and divergent perspectives on the role of generational change in shaping professional engagement were revealed. While those engaged in the early response to HIV believed younger clinicians to be less interested in the scientific and political dimensions of HIV care and more concerned about financial security and life balance, the next generation both countered and integrated these beliefs into new ways of conceptualising the value and appeal of this field of medicine. Critical appraisal of the assumptions that underpin generational discourse is essential in appreciating the changing views of providers over time, particularly in fields of medicine which have featured significant historical turning points. [ABSTRACT FROM AUTHOR]

Objective: Assess the acceptability of HIV treatment as prevention and early antiretroviral treatment among gay and bisexual men in Australia and any changes in attitudes over time. Methods: National, online, cross-sectional surveys of gay and bisexual men were repeated in 2011 and 2013. Changes in attitudes to HIV treatment over time were assessed with multivariate analysis of variance. The characteristics of men who agreed that HIV treatment prevented transmission and thought that early treatment was necessary were identified with multivariate logistic regression. Results: In total, 2599 HIV-negative, untested and HIV-positive men participated (n = 1283 in 2011 and n = 1316 in 2013). Attitudes changed little between 2011 and 2013; most participants remained sceptical about the preventative benefits of HIV treatment. In 2013, only 2.6% of men agreed that HIV treatment prevented transmission; agreement was associated with being HIV-positive, having an HIV-positive regular partner, and having received HIV post-exposure prophylaxis. In contrast, 71.8% agreed that early antiretroviral treatment is necessary; younger men were more likely and HIV-positive men and participants with HIV-positive partners were much less likely to agree with this. Conclusions: Promoting the individual health benefits of HIV treatment rather than its preventative benefits remains more acceptable to Australian gay and bisexual men. [ABSTRACT FROM AUTHOR]

Background: The science of HIV prevention and treatment is evolving rapidly, resulting in renewed calls to increase rates of HIV testing and, in particular, facilitate the timely and possibly earlier initiation of treatment, as this has the potential to dramatically reduce new infections. Little is known about how to engage nonHIV specialist Australian general practitioners (GPs) with these new priorities. Methods: Content related to the engagement of nonHIV specialist GPs in the HIV response was identified within the transcripts of in-depth interviews with policy key informants (n = 24) and general practice clinicians (n = 47) engaged with HIV medicine. A qualitative analysis of the semantic meaning of this content identified three categories of 'issues' described by participants. Results: Educational issues referred to a lack of attention to HIV in medical curricula, a perception that HIV care is only provided by HIV-specialist GPs, a need to make HIV testing more 'routine' in GP education and a need to strengthen GP awareness of referral options. Organisational issues encompassed time pressures in general practice, and a need for general practice nurses and for rapid testing to become available, as well as formalised peer mentoring and comanagement opportunities. Societal issues included the changing dynamics of HIV transmission and a need to reconnect GPs with the Australian HIV response. Conclusions: To successfully engage nonHIV specialist GPs in the promotion of regular HIV testing and timely initiation of treatment, challenging issues affecting their capacity and willingness must be urgently addressed. [ABSTRACT FROM AUTHOR]

Background: HIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine. Methods: As part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings. Results: The rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the 'coalface' and the 'cutting edge', and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change. Conclusions: Approaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce. [ABSTRACT FROM AUTHOR]

Objectives To investigate willingness to use HIV preexposure prophylaxis (PrEP) and the likelihood of decreased condom use among Australian gay and bisexual men. Methods A national, online cross-sectional survey was conducted in April to May 2011. Bivariate relationships were assessed with χ² or Fisher's exact test. Multivariate logistic regression analysis was performed to assess independent relationships with primary outcome variables. Results Responses from 1161 HIV-negative and untested men were analysed. Prior use of antiretroviral drugs as PrEP was rare (n=6). Just over a quarter of the sample (n=327; 28.2%) was classified as willing to use PrEP. Willingness to use PrEP was independently associated with younger age, having anal intercourse with casual partners (protected or unprotected), having fewer concerns about PrEP and perceiving oneself to be at risk of HIV. Among men who were willing to use PrEP (n=327), only 26 men (8.0%) indicated that they would be less likely to use condoms if using PrEP. The likelihood of decreased condom use was independently associated with older age, unprotected anal intercourse with casual partners (UAIC) and perceiving oneself to be at increased risk of HIV. Conclusions The Australian gay and bisexual men the authors surveyed were cautiously optimistic about PrEP. The minority of men who expressed willingness to use PrEP appear to be appropriate candidates, given that they are likely to report UAIC and to perceive themselves to be at risk of HIV. [ABSTRACT FROM AUTHOR]

Objectives HIV care is provided in a range of settings in Australia, but advances in HIV treatment and demographic and geographic changes in the affected population and general practitioner (GP) workforce are testing the sustainability of the special role for GPs. This paper explores how a group of 'key informants' described the role of the GP in the Australian approach to HIV care, and conceptualised the challenges currently inspiring debate around future models of care. Methods A thematic analysis was conducted of semistructured interviews carried out in 2010 with 24 professionals holding senior roles in government, non-government and professional organisations that influence Australian HIV care policy. Results The strengths of the role of the GP were described as their community setting, collaborative partnership with other medical and health professions, and focus on patient needs. A number of associated challenges were also identified including the different needs of GPs with high and low HIV caseloads, the changing expectations of professional roles in general practice, and barriers to service accessibility for people living with HIV. Conclusions While there are many advantages to delivering HIV services in primary care, GPs need flexible models of training and accreditation, support in strengthening relationships with other health and medical professionals, and assistance in achieving service accessibility. Consideration of how to support the GP workforce so that care can be made available in the broadest range of geographical and service settings is also critical if systems of HIV care delivery are to be realistic and cost-effective and meet consumer needs. [ABSTRACT FROM AUTHOR]

The article examines the perceptions and practices of antiretroviral treatment (ART) prescribers in Australia. Surveys of ART perscibers found that many participants in 2013 recommend early ART initiation compared with those in 2012. The primary concern of the prescibers was more on individual patient than public health benefit. Early ART initiation was deemed as treatment, not as prevention for patients diagnosed with HIV.

Background In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission., Methods: The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia's primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000-15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed., Results: Between 2000 and 2015, there were significant increases (P<0.001) in annual HIV testing (56.1-64.8%), condomless sex with casual partners (26.8-38.8%) and the proportion of HIV-positive men on HIV treatment (72.5-88.4%) and with an undetectable viral load (73.7-94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level., Conclusions: Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.

Three studies were conducted to examine the effect of group identification and normative content of social identities on healthy eating intentions and behaviour. In Study 1 (N = 87) Australian participants were shown images that portrayed a norm of healthy vs. unhealthy behaviour among Australians. Participants' choices from an online restaurant menu were used to calculate energy content as the dependent variable. In Study 2 (N = 117), female participants were assigned to a healthy or unhealthy norm condition. The dependent variable was the amount of food eaten in a taste test. Social group identification was measured in both studies. In Study 3 (N = 117), both American identification and healthiness norm were experimentally manipulated, and participants' choices from an online restaurant menu constituted the dependent variable. In all three studies, the healthiness norm presented interacted with participants' group identification to predict eating behaviour. Contrary to what would be predicted under the traditional normative social influence account, higher identifiers chose higher energy food from an online menu and ate more food in a taste test when presented with information about their in-group members behaving healthily. The exact psychological mechanism responsible for these results remains unclear, but the pattern of means can be interpreted as evidence of vicarious licensing, whereby participants feel less motivated to make healthy food choices after being presented with content suggesting that other in-group members are engaging in healthy behaviour. These results suggest a more complex interplay between group membership and norms than has previously been proposed., (Copyright © 2016. Published by Elsevier Ltd.)

Objective: To examine whether there have been recent changes in Australian antiretroviral treatment (ART) prescribers' perceptions and practices relating to early ART initiation, which was defined as commencing ART when a patient's CD4+ T-cell count approaches 500 cells/mm3 or immediately after a patient is diagnosed with HIV., Design, Participants and Setting: Self-completed, anonymous, cross-sectional surveys, targeting all ART prescribers in Australia, were conducted online in 2012 and 2013. The surveys included questions on prescriber factors, CD4+ T-cell count at which prescribers would most strongly recommend ART initiation, and perceived patient characteristics that could change prescribers' practices of early initiation of ART., Main Outcome Measures: Proportions of ART prescribers recommending early ART initiation., Results: We analysed responses from 108 participants in 2012 and 82 participants in 2013. In both years, more male than female prescribers participated. The median age of participants was 49 years in 2012 and 50 years in 2013. In both rounds, over 60% had more than 10 years' experience in treating HIV-positive patients. More prescribers in 2013 stated that they would most strongly recommend early ART initiation compared with those in 2012 (50.0% [95% CI, 38.7%-61.3%] v 26.9% [95% CI, 18.8%-36.2%]; P=0.001). The prescribers' primary concern was more about individual patient than public health benefit. Out of 824 patients for whom ART was initiated, as reported by prescribers in 2013, only 108 (13.1% [95% CI, 10.9%-15.6%]) were given ART primarily to prevent onward HIV transmission. The number of patients for whom ART was initiated was significantly associated with prescribers' HIV caseload even after adjusting for prescriber type (adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P<0.001); of the 37 who had initiated ART for 10 or more patients, 29 had a high HIV caseload. In 2013, 60 prescribers (73.2% [95% CI, 62.2%-82.4%]) reported that they routinely recommended ART to treatment-naive, asymptomatic patients with a CD4+ T-cell count of 350-500 cells/mm3., Conclusion: Our findings show increasing acceptance of and support for early ART initiation primarily as treatment and not as prevention.

As the management of HIV changes and demand for HIV health services in primary care settings increases, new approaches to engaging the general practice workforce with HIV medicine are required. This paper reports on qualitative research conducted with 47 clinicians who provide HIV care in general practice settings around Australia, including accredited HIV s100 prescribers as well as other GPs and general practice nurses. Balanced numbers of men and women took part; less than one-quarter were based outside of urban metropolitan settings. The most significant workforce challenges that participants said they faced in providing HIV care in general practice were keeping up with knowledge, navigating low caseload and regional issues, balancing quality care with cost factors, and addressing the persistent social stigma associated with HIV. Strategic responses developed by participants to address these challenges included thinking more creatively about business and caseload planning, pursuing opportunities to share care with specialist clinicians, and challenging prejudiced attitudes amongst patients and colleagues. Understanding and supporting the needs of the general practice workforce in both high and low HIV caseload settings will be essential in ensuring Australia has the capacity to respond to emerging priorities in HIV prevention and care.

Human immunodeficiency virus (HIV) and sexually transmitted infections (STI) testing rates are amongst the highest in the world among men who have sex with men (MSM) in Australia. However, notable minorities have never tested and many MSM have not tested recently. To examine testing routines and assess covariates of testing, an online survey was conducted among MSM in New South Wales. Five hundred and eighty non-HIV positive MSM (Mean age: 29.33 years) were randomized to answer questions on barriers to testing for HIV or STI. One in five (20.9 %) non-HIV-positive participants had never tested for HIV, 27.2 % had no HIV testing routines, 22.8 % had a moderate HIV testing routines, and 29.1 % had strong HIV testing routines. Similar patterning was observed for STI testing. In multivariate analyses participants' knowledge, beliefs, attitudes, subjective norms and perceived behavioral control were moderately related to HIV and/or STI testing routines and some associations were specific to either HIV or STI testing or to particular routines. Findings highlight that multiple social-cognitive factors each play a role in explaining HIV and STI testing among MSM. To effectively promote regular testing in MSM, programs face the challenge of having to address a range of hurdles, rather than a few major obstacles.

Background: The science of HIV prevention and treatment is evolving rapidly, resulting in renewed calls to increase rates of HIV testing and, in particular, facilitate the timely and possibly earlier initiation of treatment, as this has the potential to dramatically reduce new infections. Little is known about how to engage non HIV specialist Australian general practitioners (GPs) with these new priorities., Methods: Content related to the engagement of non HIV specialist GPs in the HIV response was identified within the transcripts of in-depth interviews with policy key informants (n=24) and general practice clinicians (n=47) engaged with HIV medicine. A qualitative analysis of the semantic meaning of this content identified three categories of 'issues' described by participants., Results: Educational issues referred to a lack of attention to HIV in medical curricula, a perception that HIV care is only provided by HIV-specialist GPs, a need to make HIV testing more 'routine' in GP education and a need to strengthen GP awareness of referral options. Organisational issues encompassed time pressures in general practice, and a need for general practice nurses and for rapid testing to become available, as well as formalised peer mentoring and comanagement opportunities. Societal issues included the changing dynamics of HIV transmission and a need to reconnect GPs with the Australian HIV response., Conclusions: To successfully engage non HIV specialist GPs in the promotion of regular HIV testing and timely initiation of treatment, challenging issues affecting their capacity and willingness must be urgently addressed.

While the HIV epidemic is resurging in gay communities worldwide, HIV notification rates remain stable in NSW. This outcome demonstrates the success of a well-funded partnership approach to preventing HIV infection in gay men in NSW. However, population rates of new diagnoses of HIV are similar to those seen in comparable countries and sexual risk-taking may be increasing. As the HIV epidemic has evolved, prevention in gay men has become more complex and must effectively engage with an increasing diversity of risk reduction strategies. These strategies reflect the continual adaptation of the gay community to evolving understandings of the HIV epidemic and the diverse ways in which gay men balance pleasure and prevention.