Younger age, recent HIV diagnosis, no welfare support and no annual sexually transmissible infection screening are associated with nonuse of antiretroviral therapy among HIV-positive gay men in Australia.

OBJECTIVES: With the increasing momentum to maximize the benefits of antiretroviral therapy (ART), better understanding of opportunities and challenges in increasing ART coverage and promoting early ART initiation is urgently needed. Key sociodemographic, clinical and behavioural factors associated with Australian HIV-positive gay men's current nonuse of ART were systematically examined. METHODS: Data were based on 1911 responses from HIV-positive men who had participated in the Australian Gay Community Periodic Surveys (GCPS) between 2010 and 2012. Stratified univariate analysis and multivariate logistic regression were used. RESULTS: A majority of the participants were recruited from gay community venues and events and self-identified as gay or homosexual. On average, they were 44 years old and had been living with HIV for at least 10 years. Close to 80% (n=1555) were taking ART, with >90% further reporting an undetectable viral load at the time of the survey. From 2010 to 2012, there had been a moderate increase in ART uptake [adjusted odds ratio (AOR) 1.40; 95% confidence interval (CI) 1.20-1.65]. In addition, younger age (AOR 1.66; 95% CI 1.45-1.92), recent HIV diagnosis (AOR 1.78; 95% CI 1.59-1.98), not receiving any social welfare payments (AOR 2.20; 95% CI 1.05-2.54) and no annual screening for sexually transmissible infections (AOR 1.55; 95% CI 1.03-2.34) were independently associated with ART nonuse. CONCLUSIONS: Current ART coverage among HIV-positive gay men in Australia is reasonably high. To further increase ART coverage and promote early ART initiation in this population, better clinical care and sustained structural support are needed for HIV management throughout their life course.

Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men Study.

BACKGROUND: Early detection and treatment of bacterial sexually transmitted infections has been advocated as an HIV prevention strategy. AIM: To inform screening guidelines, the incidence and risk factors for urethral and anal gonorrhoea and chlamydia were studied in a prospective cohort of community-based HIV negative homosexual men in Sydney, New South Wales, Australia. METHODS: All participants were offered annual screening for gonorrhoea and chlamydia (study-visit diagnoses) on urine and anal swabs using nucleic acid amplification. Participants also reported diagnoses of gonorrhoea and chlamydia made elsewhere between interviews (interval diagnoses). All diagnoses were summed to create a combined incidence rate, and detailed data on specific sexual practices with casual and regular partners were collected. RESULTS: Among 1427 men enrolled, the combined incidence rates were 3.49 and 2.96 per 100 person-years for urethral and anal gonorrhoea, respectively; and 7.43 and 4.98 per 100 person-years for urethral and anal chlamydia, respectively. Urethral infections were associated with unprotected anal intercourse (UAI) with HIV-positive partners (hazard ratio (HR) = 2.58, 95% CI 1.10 to 6.05 for urethral gonorrhoea) and with frequent insertive oral sex (p for trend 0.007 for urethral chlamydia). Anal infections were associated with receptive UAI (p for trend 0.001 for both anal gonorrhoea and chlamydia) and other receptive anal sexual practices. Stratified analyses showed the independence of the associations of insertive oral sex with urethral infections and of non-intercourse receptive anal practices with anal infections. CONCLUSION: Incident gonorrhoea and chlamydia were common. Risk behaviours for both urethral and anal infections were not restricted to UAI. Screening that includes tests for anal and urethral infections should be considered for all sexually active homosexual men, not just for those who report UAI.