Adjusting Behavioural Surveillance and Assessing Disparities in the Impact of COVID-19 on Gay and Bisexual Men's HIV-Related Behaviour in Australia.

COVID-19 has disrupted sexual behaviour and access to health systems. We adapted regular HIV behavioural surveillance of gay and bisexual men (GBM) in Australia in response to COVID-19, assessed the impact on the profile of the sample, the participants' HIV-related behaviour, and whether COVID-19 may have accentuated existing disparities in the Australian HIV epidemic. Data collected from five states during July 2017-June 2021 were included (N = 31,460). The emphasis on online recruitment after COVID-19 led to smaller sample sizes, greater geographic reach, and a higher proportion of bisexual-identifying participants. Most participants (88.1%) reported physical distancing and 52.1% had fewer sex partners due to COVID-19. In the COVID-19-affected rounds (July 2020-June 2021), the number of male partners, recent HIV testing and pre-exposure prophylaxis (PrEP) use all fell, and HIV risk among the smaller group of participants who reported casual sex increased. COVID-related changes were generally more pronounced among GBM aged under 25 years, participants from suburbs with fewer gay residents, and bisexual men. These groups should be prioritised when encouraging GBM to reengage with HIV testing services and effective prevention methods, like condoms and PrEP.

RESUMEN: COVID-19 ha interrumpido el comportamiento sexual y el acceso a los sistemas de salud. Adaptamos la vigilancia regular del comportamiento de hombres homosexuales y bisexuales (GBM) hacia el VIH en Australia en respuesta a COVID-19, evaluamos el impacto en el perfil de la muestra, el comportamiento relacionado con el VIH de los participantes y si COVID-19 puede haber acentuado las existentes disparidades en la epidemia australiana de VIH. Se incluyeron los datos recopilados de cinco estados entre julio de 2017 y junio de 2021 (N = 31 460). El énfasis en el reclutamiento en línea después de COVID-19 resulto en tamaños de muestra más pequeños, mayor alcance geográfico y una mayor proporción de participantes que se identifican como bisexuales. La mayoría de los participantes (88,1%) describieron participando en el distanciamiento físico y el 52,1% tuvo menos parejas sexuales debido a la COVID-19. En las rondas afectadas por COVID-19 (julio de 2020 a junio de 2021), disminuyó la cantidad de parejas masculinas, el uso reciente de pruebas de VIH y de la profilaxis previa a la exposición (PrEP), y el riesgo de VIH entre el grupo más pequeño de participantes que participaron en sexo casual aumentó. Los cambios relacionados con COVID fueron generalmente más pronunciados entre GBM menores de 25 años, participantes de suburbios con menos residentes homosexuales y hombres bisexuales. Se debe priorizar a estos grupos al alentar a GBM a volver a comprometerse con los servicios de pruebas de VIH y métodos de prevención efectivos, como condones y PrEP.

Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998-2020.

Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.