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Introduction: We determined the contribution of undiagnosed HIV to new infections among gay and bisexual men (GBM) over a 12-year period in Australia where there has been increasing focus on improving testing and HIV treatment coverage. Methods: We generated annual estimates for each step of the HIV cascade and the number of new HIV infections for GBM in Australia over 2004 to 2015 using relevant national data. Using Bayesian melding we then fitted a quantitative model to the cascade and incidence estimates to infer relative transmission coefficients associated with being undiagnosed, diagnosed and not on ART, on ART with unsuppressed virus, or on ART with suppressed virus. Results: Between 2004 and 2015, we estimated the percentage of GBM with HIV in Australia who were unaware of their status to have decreased from 14.5% to 7.5%. During the same period, there was a substantial increase in the number and proportion of GBM living with HIV on treatment and with suppressed virus, with the number of virally suppressed GBM increasing from around 3900 (30.2% of all GBM living with HIV) in 2004 to around 14,000 (73.7% of all GBM living with HIV) in 2015. Despite the increase in viral suppression, the annual number of new infections rose from around 660 to around 760 over this period. Our results have a wide range due to the uncertainty in the cascade estimates and transmission coefficients. Nevertheless, undiagnosed GBM increasingly appear to contribute to new infections. The proportion of new infections attributable to undiagnosed GBM almost doubled from 33% in 2004 to 59% in 2015. Only a small proportion ( Discussion: Our study suggests that an increase in HIV treatment coverage in Australia has reduced the overall risk of HIV transmission from people living with HIV. However, the proportion of infections and the rate of transmission from undiagnosed GBM has increased substantially. These findings highlight the importance of HIV testing and intensified prevention for Australian GBM at high risk of HIV. Keywords: Australia; gay and bisexual men; mathematical model; transmission dynamics; undiagnosed HIV; HIV cascade, 1 | INTRODUCTION People with undiagnosed HIV contribute disproportionately to HIV transmission because the early stages of infection are the most infectious, and without treatment an individual remains infectious [1-7]. [...]

: Introduction: Gay and bisexual men (GBM) are at increased risk of hepatitis C/HIV co?infection. In Australia, the availability of subsidized direct?acting antiviral treatment for hepatitis C has rendered eliminating co?infection possible. High reinfection rates in subgroups with continued exposure may compromise elimination efforts. To inform the development of hepatitis C risk reduction support in GBM, we explored reinfection risk perceptions and attitudes among GBM living with HIV recently cured from hepatitis C. Methods: Between April and August 2017, 15 GBM living with diagnosed HIV were recruited from high caseload HIV primary care services in Melbourne following successful hepatitis C treatment. In?depth interviews were conducted exploring understandings of hepatitis C risks, experiences of co?infection and attitudes towards reinfection. Constructivist grounded theory guided data aggregation. Results: Participants? understandings of their hepatitis C infection and reinfection trajectories were captured in three categories. Hepatitis C and HIV disease dichotomies: Hepatitis C diagnosis was a shock to most participants and contrasted with feelings of inevitability associated with HIV seroconversion. While HIV was normalized, hepatitis C was experienced as highly stigmatizing. Despite injecting drug use, interviewees did not identify with populations typically at risk of hepatitis C. Risk environments and avoiding reinfection: Interviewees identified their social and sexual networks as risk?perpetuating environments where drug use was ubiquitous and higher risk sex was common. Avoiding these risk environments to avoid reinfection resulted in community disengagement, leaving many feeling socially isolated. Hepatitis C care as a catalyst for change: Engagement in hepatitis C care contributed to a better understanding of hepatitis C risks. Interviewees were committed to applying their improved competencies around transmission risk reduction to avoid reinfection. Interviewees also considered hepatitis C care as a catalyst to reduce their drug use. Conclusions: Hepatitis C/HIV co?infection among GBM cannot be understood in isolation from co?occurring drug use and sex, nor as separate from their HIV infection. Hepatitis C prevention must address subcultural heterogeneity and the intersectionality between multiple stigmatized social identities. Hepatitis C care presents an opportunity to provide support beyond cure. Peer support networks could mitigate social capital loss following a commitment to behaviour change and reduce hepatitis C reinfection risks., Introduction Hepatitis C virus (HCV) infection is a significant public health threat; in 2015, an estimated 71 million people worldwide had chronic HCV infection. Due to shared modes of transmission, [...]

During recent years in France, the number of HIV infections in the gay community has been constantly increasing. How can we explain the number of transmissions being still so prevalent? Since the arrival effective therapies, HIV may no longer be perceived as a fatal disease, and therefore it may have become trivialized. This paper will merge variables linked to homophobia and interiorized homophobia in order to bring a new insight in understanding to the motivations of gay men having non protected sex, whether it is systematic or episodic. Interiorized homophobia appears to be an essential element of the construction of the identity among gay men. A real 'coping strategy', it allows firstly a protection from the surrounding environment, but in a second step becomes harmful to the development of healthy self-esteem. Gay men partially construct their identity from elements such as heterosexism and insults targeting gays as feminine, submissive individuals. We suggest that unprotected sex between men answers a quest for identity. On the one hand, there is an act of virility with unprotected sex and transmission of seminal fluids and exposure to a risk, reinforcing the masculine side. On the other hand, we can see identification with homophobic rejection, and becoming the carrier of a contagious, chronic, rejected disease. It is in this status of rejection--the transfer from homophobia to the disease--that gay men may find themselves. This paper proposes to approach the phenomenon in a replay of previous contributions on this topic. Keywords: internalized homophobia, HIV infection, unprotected sex, gay identity, There are about 7,000 new cases of HIV in France each year. The epidemic touches every demographic, but among gay men, it has been rising, despite the fact that the [...]

I'M THE LUCKIEST unlucky person in the world. No one wants to be the last man standing,' reflected Peter Greene, one of the eight long-term HIV survivors from the San [...]

The HIV epidemic in the United States has affected at least two generations of gay men. Despite numerous efforts to intervene on this public health crisis, HIV infections continue to escalate, especially among young men. This condition is compounded by an ever-growing number of gay men who are aging and living with HIV. We must enact an innovative and proactive vision and framework for HIV prevention that moves us beyond the undertakings rooted in social--cognitive paradigms that have informed this work jot the past 25 years. A new framework for HIV prevention must give voice to gay men: must consider the totality of their lives: must delineate the underlying logic, which directs their relation to sex and HIV: and must concurrently respect their diverse life experiences. This approach should be rooted in a biopsychosocial paradigm, should be informed by both theory and practice, and should be directed by three theoretical lenses--a theory of syndemics, developmental theories, and contextual understandings of HIV disease. Taken together, these elements are a call to action for research and practice psychologists who are working to improve the lives of gay men. Keywords: gay men, HIV prevention, syndemics, development, context

The administration of antiretrovirals before HIV exposure to prevent infection (i.e., preexposure prophylaxis; PREP) is under evaluation in clinical trials. Because PrEP is based on antiretrovirals, there is considerable concern that it could substantially increase transmitted resistance, particularly in resource-rich countries. Here we use a mathematical model to predict the effect of PrEP interventions on the HIV epidemic in the men-who-have-sex-with-men community in San Francisco. The model is calibrated using Monte Carlo filtering and analyzed by constructing nonlinear response hypersurfaces. We predict PrEP interventions could substantially reduce transmission but significantly increase the proportion of new infections caused by resistant strains. Two mechanisms can cause this increase. If risk compensation occurs, the proportion increases due to increasing transmission of resistant strains and decreasing transmission of wild-type strains. If risk behavior remains stable, the increase occurs because of reduced transmission of resistant strains coupled with an even greater reduction in transmission of wild-type strains. We define this as the paradox of PrEP (i.e., resistance appears to be increasing, but is actually decreasing). We determine this paradox is likely to occur if the efficacy of PrEP regimens against wild-type strains is greater than 30% and the relative efficacy against resistant strains is greater than 0.2 but less than the efficacy against wild-type. Our modeling shows, if risk behavior increases, that it is a valid concern that PrEP could significantly increase transmitted resistance. However, if risk behavior remains stable, we find the concern is unfounded and PrEP interventions are likely to decrease transmitted resistance. mathematical model | men who have sex with men | prevention | epidemics | antiretrovirals doi/10.1073/pnas.1006061107

Objectives. We examined differences in sexual partner selection between Black and White men who have sex with men (MSM) to better understand how HIV status of participants' sexual partners and related psychosocial measures influence risk taking among these men. Methods. We collected cross-sectional surveys from self-reported HIV-negative Black MSM and White MSM attending a gay pride festival in Atlanta, Georgia, Results, HIV-negative White MSM were more likely than were HIV-negative Black MSM to report having unprotected anal intercourse with HIV-negative men, and HIV-negative Black MSM were more likely than were HIV-negative White MSM to report having unprotected anal intercourse with HIV status unknown partners. Furthermore, White MSM were more likely to endorse serosorting (limiting unprotected partners to those who have the same HIV status) beliefs and favorable HIV disclosure beliefs than were Black MSM Conclusions. White MSM appear to use sexual partner--related risk reduction strategies to reduce the likelihood of HIV infection more than do Black MSM. Partner selection strategies have serious limitations; however, they may explain in part the disproportionate number of HIV infections among Black MSM, (Am J Public Health, 2010;100:503-509. doi: 10.2105/AJPH.2008.155903)

Background: Multiple PrEP studies suggest incidence of bacteria STIs among gay and bisexual men (GBM) increases following PrEP initiation, possibly due to changes in behaviour, sexual networks or testing. Regular, asymptomatic STI testing of PrEP users (Australian guidelines recommend three-monthly) may also help suppress incidence longer-term. Using national sentinel surveillance data, we report trends in STI incidence among GBM PrEP-users. Methods: Retrospective patient data were extracted from 35 clinics, with individuals' records linked between clinics. HIV-negative GBM with evidence of TDF/FTC prescription (excluding PEP) contributed person-time from their first subsequent STI test and were censored at their last test or six months after their last PrEP script. Censored participants could re-enter at PrEP re-initiation. Infection date was imputed as a random date between diagnosis and previous negative test. Using Poisson regression, we estimated half-yearly incidence and assessed trends (July 2016-December 2019) for syphilis, chlamydia and gonorrhoea, overall and stratified by anatomical site and age (35 years). To account for selection bias associated with differences in characteristics of GBM initiating PrEP over time, a closed-cohort analysis was conducted among GBM continuously using PrEP across the study period. Results: Among 17,250 PrEP-users contributing 24,823 person-years (median time between tests = 84 days) chlamydia (51.3/100 py to 39.1/100 py; p < 0.001) and gonorrhoea (43.1/100 py to 32.8/100 py; p < 0.001) incidence declined, whereas syphilis incidence increased (6.4/100 py to 9.9/100 py; p > 0.001). Among 3498 continuous-PrEP-users (10,538 person-years), declines were observed for overall chlamydia (54.0/100 py to 42.3/100 py; p < 0.001) and gonorrhoea (43.8/100 py to 34.9/100 py; p < 0.001) incidence; pharyngea chlamydia (p = 0.116) and urogenital gonorrhoea (p = 0.973) were stable, and syphilis incidence increased (6.8/100 py to 11.8/100 py; p < 0.001). For both cohorts, gonorrhoea and chlamydia incidence were greater among GBM < 35 years, with declines most prominent among those [greater than or equal to] 35 years. Syphilis rates and trends did not differ by age. Conclusions: Representing the largest cohort analysis of STI incidence among PrEP-users reported internationally, these data suggest that initial increases in incidence of some STIs following PrEP initiation may be attenuated over time. Frequent testing or changes in the risk profile of PrEP initiates over time may explain some reductions. Risk-mitigation strategies may be needed for younger GBM and to curtail syphilis incidence., OA16.01 M. Traeger (1); J. Asselin (1); C. El-Hayek (1); J. Dittmer (1); E.Wright (2); A. Carter (3); T. Vickers (3); P. Patel (3); C. Fairley (4); B. Donovan (3); [...]

According to the Centers for Disease Control and Prevention, men who have sex with men account for the largest proportion of cumulative AIDS cases among Asian Pacific Islanders. Yet little is known about the factors that need to be addressed in developing culturally competent intervention strategies for members of this group. This article explores what factors HIV prevention service providers and active volunteers who are also members of the groups that they serve believe need to be addressed before a culturally appropriate intervention strategy for gay, bisexual, and queer Asian Pacific Islander men can be developed. Fifteen men participated in three focus groups, and seven of the men completed in-depth individual interviews regarding larger issues that are often ignored in intervention. Analysis of qualitative data revealed five issues that participants said need to be addressed when working with members of this group. KEY WORDS: gay Asian Pacific Islander men; HIV,' risk reduction, Although still limited and in need of further examination, significant progress has been made in determining the factors that contribute to unsafe sexual behavior among Asian Pacific Islander (API) men [...]

This randomized clinical trial (N = 253) evaluated the efficacy of a theory-based intervention designed to reduce both alcohol use and incidence of unprotected sexual behaviors among HIV-positive men who have sex with men with alcohol use disorders. An integrated, manualized intervention, using both individual counseling and peer group education/support, was compared with a control condition in which participants received resource referrals. The intervention was based on the transtheoretical model's stages and processes of change, and motivational interviewing was used to enhance client readiness for change. Major findings include treatment effects for reduction in number of drinks per 30-day period, number of heavy drinking days per 30-day period, and number of days on which both heavy drinking and unprotected sex occurred. Practitioners employing this intervention may achieve enhanced client outcomes in reduction of both alcohol use and risky sexual behavior. Keywords: HIV, transtheoretical model, motivational interviewing

The authors examined the effectiveness of motivational interviewing (MI) on club drug use and risky sex in non-treatment-seeking men who have sex with men (MSM). MSM (N = 150) were assessed and randomly assigned to 4 sessions of MI or an educational control intervention. Follow-up occurred at quarterly intervals for 1 year. Primary outcomes were days of any club drug use and number of unsafe sex acts. On average, club drug use declined during follow-up. A significant interaction effect showed that MI was associated with less club drug use during follow-up compared with education but only among participants with lower severity of drug dependence (p < .02; small to medium effect size). MI did not result in a significant reduction in risky sex relative to education. The results support the use of MI targeting club drug use in at-risk or mildly dependent users not seeking treatment but not in more severely dependent users. MI does not appear effective in reducing risky sexual behavior in this population. Keywords: MSM, club drugs, sexual risk behavior, motivational interviewing