Australian Gay Men Research Articles

Measuring and understanding the attitudes of Australian gay and bisexual men towards biomedical HIV prevention using cross-sectional data and factor analyses

IntroductionContemporary responses to HIV embrace biomedical prevention, particularly treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP). However, large-scale implementation of biomedical prevention should be ideally preceded by assessments of their...

Negotiating gay men’s relationships: how are monogamy and non-monogamy experienced and practised over time?

When viewed over time, many gay men’s relationships are not static, or firmly fixed to monogamy or non-monogamy. This paper uses in-depth interviews with 61 Australian gay men to explore how monogamy and non-monogamy are experienced over time, expectations of what constitutes the norms regarding gay men’s relationships and how couples experience and practices change. Although some gay men may idealise monogamy, particularly at the beginning of a relationship, it is often experienced as temporary. Non-monogamy is often seen as a likely prospect for gay relationships owing to the social and cultural norms that operate in gay communities. These expected trajectories are reflected in practice – many relationships begin monogamously and then become non-monogamous over time. While the application of ‘rules’, experimentation and flexibility can facilitate change, couples may struggle to navigate new territory as their relationship structures shift. This is particularly the case when partners value monogamy and non-monogamy differently, or when one partner’s values change. These findings shed light on how gay men approach change to the status of ‘fidelity’ within their relationships, and the tensions and opportunities that change can produce for couples.

Measuring drug use sensation-seeking among Australian gay and bisexual men

BackgroundGay and bisexual men (GBM) use illicit drugs at higher rates than most other population groups and their use has been associated with sexual risk behavior. The measure of sexual sensation-seeking has been a useful tool for understanding sexual risk behavior in this population, but there is no equivalent measure for sensation-seeking in relation to drug-using behaviors. ObjectiveThis paper explores baseline associations with illicit drug use in an online prospective observational study of licit and illicit drug use among GBM. We describe the development of a measure of drug-use sensation-seeking, and its association with illicit drug use. MethodsAustralian GBM were invited to enroll online through social networking and gay community sites. Between September 2014 and July 2015, a total of 2251 GBM completed the questionnaire and 1900 men provided useable baseline data on items designed to measure drug use sensation-seeking. ResultsMean age was 32.8 years (SD 12.7). Half (50.7%) had used illicit drugs within the previous six months. Among these 963 recent users, 27.3% had used illicit drugs weekly or more often. Responses to items to measure drug use sensation-seeking formed a reliable scale (α=0.944). Within the total sample, any illicit drug use within the previous six months was associated with a higher score on the measure of drug use sensation-seeking (aOR=1.18; 95%CI=1.16–1.20). When we restricted our analyses to men who reported recent illicit drug use, it was also associated with using those drugs at least weekly in the previous six months (aOR=1.09; 95%CI=1.07–1.11). ConclusionWe developed a reliable measure of drug use sensation-seeking for this sample of GBM. Our measure predicted any use of illicit drugs within the total sample, and when restricted to men who reported illicit drug use, it also predicted more frequent use of those drugs.

The Center for Epidemiologic Studies Depression Scale: Invariance across heterosexual men, heterosexual women, gay men, and lesbians.

The present study examined measurement invariance of the Center for Epidemiologic Studies Depression Scale (CES-D) in community groups of Australian heterosexual men (N = 1106), heterosexual women (N = 2111), gay men (N = 527), and lesbians (N = 712). Confirmatory factor analysis of CES-D item scores supported the theorized oblique 4-factor model. There was support for full measurement invariance across the 4 groups, based on differences in approximate fit indices. In contrast there was support for only partial invariance when the chi-square difference test was applied. Lack of invariance was mostly for depressed affect and somatic symptom items, with noninvariant somatic symptom items showing consistently high factor loadings and thresholds among lesbians compared with the other groups. The findings are discussed in relation to the use of the CES-D, the relevance of different depression symptoms to how depressions is experienced by the different gender and sexual orientation groups, and gender role socialization and minority sexual orientation theories. (PsycINFO Database Record

Change in subjective social status following HIV diagnosis and associated effects on mental and physical health among HIV-positive gay men in Australia

Objective: This study investigates the impact of HIV diagnosis on subjective social status and if changes are linked to health outcomes.Design: Two measures of subjective social status, socio-economic and standing in the community were examined in 342 Australian HIV-positive gay men in 2014. Participants recalled ratings at diagnosis were compared with current ratings.Main outcome measures: Self-reported mental (psychological distress, self-esteem, positive mental health and satisfaction with life) and physical health (self-rated health, CD4 count, viral load).Results: Half of the participants reported improvements in subjective socio-economic status (59%) or standing in the community (52%) since diagnosis, yet one quarter reported socio-economic status (25%) or standing in the community had decreased (23%). Increases in either measure of subjective social status were linked to higher self-esteem, positive mental health, satisfaction with life and better self-rated health. Decreases in subjective social status, however, were strongly linked to poorer outcomes on all mental health measures. Decreases in standing in the community were also associated with poorer physical self-rated health.Conclusion: Most participants reported their subjective social status were the same or better since diagnosis. Changes in subjective social status following diagnosis were strongly linked to mental health outcomes. Those who reported a decrease in subjective social status were particularly vulnerable to mental health problems.

Vaccine-preventable anal human papillomavirus in Australian gay and bisexual men

ObjectiveHPV causes ~90% of anal cancer and HPV16 is the type most commonly associated with anal cancer. Gay and bisexual men (GBM) are at greatly increased risk. We investigated patterns of vaccine-preventable anal HPV in older GBM. MethodsThe Study of the Prevention of Anal Cancer (SPANC) is an ongoing, prospective cohort study of HIV-positive and HIV-negative Australian GBM. Participants completed questionnaires and underwent an anal swab for HPV genotyping using Roche Linear Array. We analysed baseline data from SPANC by HPV type, mean number of types, stratified by age and HIV status. ResultsAnal HPV results from 606 (98.2%) of 617 participants (median age 49 years, 35.7% HIV-positive) showed 525 (86.7%) had ≥1 HPV type and 178 (29.4%) had HPV16. Over one third of participants (214, 35.3%) had no nonavalent vaccine-preventable types detected. Two (0.3%) participants had all quadrivalent types and none had all nonavalent vaccine types. HIV-positive participants (p<0.001) and younger participants (p=0.059) were more likely to have more vaccine-preventable HPV types detected. ConclusionAnal HPV was highly prevalent in this largely community-based GBM cohort. Vaccine-preventable HPV16 was detected in approximately one third of participants. These findings suggest that the potential efficacy of HPV vaccination of older GBM should be explored.

Abjection. Objection. Subjection: rethinking the history of AIDS in Australian gay men’s futures

In coining the term ‘post-AIDS’ some 20 years ago, I was noting the dissolution of a singular and unified experience of HIV and AIDS for gay communities that had been the case until that time. Not only were HIV-positive and HIV-negative gay men having increasingly different experiences, but divergent trajectories were opening up. Since then, many other factors have come into play, for example age and generation; the ascendancy of the biomedical and the technosexual; and the supremacy of neoliberal politics (including sexual politics). Now, if gay men are to survive as such – and there is a question about this – are there larger issues than HIV and AIDS that ought to command our attention? Or do we need to rethink how we situate HIV and AIDS within the larger framework of gay men’s health and wellbeing. This might be just a question of politics, or it could be a question of theory. Are we finally returning to the original gay liberation agenda of the eradication of difference, or simply being traduced (seduced?) by our success at intimate citizenship?

Willingness to use and have sex with men taking HIV pre-exposure prophylaxis (PrEP): results of online surveys of Australian gay and bisexual men, 2011–2015

ObjectiveAssess willingness to use HIV pre-exposure prophylaxis (PrEP), support for others using it and willingness to have sex with partners using PrEP among Australian gay and bisexual men (GBM).MethodsNational, online...

How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men.

An online, cross-sectional survey of Australian GBM was conducted. Univariate and multivariate generalised estimating equations were used to determine statistical associations. 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. 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.

Australian gay and bisexual men’s online preferences about sex with HIV-positive partners

This study reviewed 57178 Australian online profiles obtained directly from a popular gay website. Logistic regression was used to identify factors associated with preferences for meeting HIV-positive partners. Men could indicate their preferences from a list of 22 types of partners; 4358 profiles (7.6%) indicated an interest in meeting HIV-positive men. There were 1959 profiles (3.4%) listing a preference for 21 of the 22 types of men, including 1498 men (2.6%) that specifically excluded HIV-positive men. Men who specifically excluded HIV-positive men on their profiles were younger (mean age 34.7 years), less likely to identify as gay (25.6%) and more likely to always prefer 'safer sex' (55.3%) than those who specifically included them (mean age 39.6 years; 62.8% gay-identified; 30.9% preferred safer sex; P<0.001). Men who specifically excluded HIV-positive partners on their profiles were also more likely to live outside major capital cities (P<0.001). Being younger, living outside major cities, not identifying as gay, always preferring safer sex and either Caucasian or Asian background were associated with excluding HIV-positive men as potential sex partners. These factors may reflect lower social and community engagement with the gay community. The disinclination to include HIV-positive men as potential sex partners may be due to fear of infection, stigma or poor information about HIV.

Internalized Homonegativity, Sense of Belonging, and Depressive Symptoms Among Australian Gay Men

ABSTRACTInternalized homonegativity has been directly linked to depression among gay men. The aim of the study was to test whether internalized homonegativity is indirectly related to depressive symptoms via a sense of belonging to the broad gay community, gay groups, gay friends, and the general community. A sample of 246 self-identified Australian gay men, aged 18–82 years, completed the Internalized Homophobia Scale, the Psychological subscale of the Sense of Belonging Instrument, the Sense of Belonging Within Gay Communities Scale, and the Centre for Epidemiological Studies Depression Scale. Results indicated that the final model was an excellent fit to the data. Internalized homonegativity was indirectly related to depressive symptoms via sense of belonging to gay groups, with gay friends, and to the general community. Interventions aimed at reducing internalized homonegativity among gay men have the potential to enhance sense of belonging and, in turn, decrease depressive symptoms.

Psychosocial factors associated with flourishing among Australian HIV-positive gay men.

BackgroundMental health outcomes among HIV-positive gay men are generally poorer than in the broader population. However, not all men in this population experience mental health problems. Although much is known about factors associated with depression and anxiety among HIV-positive gay men, little is known about factors associated with positive mental health. Such knowledge can be useful for optimizing well-being support programs for HIV-positive gay men.MethodsIn this study, we examined flourishing, which broadly covers most aspects of positive mental health. A sample of 357 Australian HIV-positive gay men completed a survey on their mental health and well-being, including the Flourishing Scale. Given the lack of previous research, we explored a wide range of psychosocial factors, including demographics, stigma, discrimination, and social support, to identify key factors linked to flourishing.ResultsThe sample showed a similar level of flourishing to those in general population samples. Several independent factors were found to be associated with flourishing outcomes. Those who were most likely to be flourishing tended to have low or no internalized HIV-related stigma, were employed, received higher levels of practical support, had a sense of companionship with others, and felt supported by family.ConclusionsThese and other findings presented in this article may be used to help inform strategies for promoting optimal levels of mental health, and its associated general health benefits, among HIV-positive gay men.

The relationship between living alone and depressive symptoms among older gay men: the moderating role of sense of belonging with gay friends.

Living alone is a risk factor for depressive symptoms among older adults, although it is unclear if it is a risk factor for older gay men. A sense of belonging to the gay community is protective and might compensate for living alone. This research investigated whether a sense of belonging with gay friends weakened the relationship between living alone and depressive symptoms among older gay men. A community sample of 160 Australian gay men aged 65-92 years completed the Center for Epidemiologic Studies Depression Scale and two visual analogue scales assessing a sense of belonging with gay friends. Results supported the moderation model, with increasing levels of belonging with gay friends weakening the relationship between living alone and depressive symptoms. Results imply that enhancing a sense of belonging with gay friends among older gay men who live alone is likely to be a protective factor in relation to depressive symptoms.

The Mental Health Impact of Physical Appearance Concerns in the Context of Other Life Domains Among Australian Gay Men.

Previous studies have identified gay men as a high-risk population for body image disturbances. However, little research has examined the mental health impact of gay men's physical appearance concerns in the context of other major life domains. The present study addressed this gap by investigating how mental health outcomes (satisfaction with life, self-esteem, positive well-being, and psychological distress) were associated with satisfaction with and importance of physical appearance, work, family relationships, friendships, health and fitness, and sex life among Australian gay men aged 18-39. The possible moderating role of intimate relationship status was also examined. Results from an online survey revealed that greater satisfaction with physical appearance, work, family, and friendships all had similar positive associations with mental health. However, more importance placed on physical appearance was more consistently associated with poorer mental health compared with the subjective importance of other domains. Findings also indicated the associations between physical appearance satisfaction and life satisfaction, and between physical appearance importance and positive well-being, were weaker for those in relationships. Thus, physical appearance matters in gay men's lives, but was only one factor when considered in the broader context of other life areas that contributed to overall well-being. These findings suggest the need for a nuanced and contextualized understanding of how physical appearance concerns fit into gay men's lives.

Gay and bisexual men’s interest in marriage: an Australian perspective

Same-sex marriage is a widely debated issue, including in Australia. This study used an online anonymous survey, with free-text responses, to investigate romantic and sexual relationships among Australian gay and bisexual men. We sought to identify what proportion of such men intended to marry their primary regular partner if marriage was made legally available to same-sex couples in Australia, as well as factors associated with intention or non-intention to marry. Most men in the sample did not intend to marry their primary regular partner. Even among men who considered themselves to be in a ‘relationship’ with their primary regular partner, less than half intended to marry him. However, many men who would not marry their current primary regular partner agreed that same-sex marriage should be available for gay and bisexual men in Australia. Reasons for intention to marry included a desire for social and legal equality, and ideas about marriage as a rite of passage, an expression of love and the most valued form of relationship in Australia. Those who did not intend to marry their primary regular partner offered a number of reasons, including that the nature of their relationship was incompatible with marriage, and reported a critical position towards marriage as a heteronormative institution.

The use of mobile phone apps by Australian gay and bisexual men to meet sex partners: an analysis of sex-seeking repertoires and risks for HIV and STIs using behavioural surveillance data

BackgroundMobile phone apps are now the most popular method that Australian gay men use to find sex partners. Partner-seeking mobile phone apps use location functions to identify like-minded men and...

Rejected by Family for Being Gay or Lesbian: Portrayals, Perceptions, and Resilience

ABSTRACTA myriad of negative psychosocial outcomes face gay men and lesbians who experience rejection by their family for not being heterosexual. However, what constitutes rejection is not clear, and, more importantly, it is not known how resilience is fostered within such a context. This qualitative study sought to examine these issues by exploring the lived experiences of Australian gay men and lesbians who were previously or were currently experiencing family rejection because of their sexuality. A total of 21 in-depth, semistructured interviews were individually conducted and analyzed. Thematic analysis of the interviews revealed several themes that provided greater understanding of the portrayals and perceptions of family rejection; the impact of family rejection on mental health; and, importantly, how these individuals came to establish resilience in the face of experiencing family rejection. Limitations, directions for future research, and clinical implications of the findings are also discussed.

Psychosocial Factors Associated with Resilience in a National Community-Based Cohort of Australian Gay Men Living with HIV.

HIV-positive gay men may experience multiple sources of adversity and stress, related both to their HIV diagnosis and sexual identity. Most of these men, however, do not experience mental health problems. Little is known about factors that help them achieve resilience in the face of life challenges. This study examined psychosocial factors associated with resilience in a national community-based sample of 357 Australian HIV-positive gay men. Resilience was measured using the Connor-Davidson Resilience Scale. Higher levels of resilience were linked with experiencing low or no internalized HIV-related stigma, having no previous history of mental health problems, and a number of socioeconomic indicators. In addition to providing a more complete picture of the mental health of HIV-positive gay men, findings from this study can be used to inform strength-based approaches to mental health prevention and support.

Increasing Belief in the Effectiveness of HIV Treatment as Prevention: Results of Repeated, National Surveys of Australian Gay and Bisexual Men, 2013-15.

We surveyed Australian gay and bisexual men, assessing belief in HIV treatment as prevention (TasP) and support for early treatment. We identified the characteristics of participants who believed in TasP and supported early treatment using multivariate logistic regression. In 2013, 1316 men participated; 1251 participated in 2015. Belief in TasP increased from 2.6% in 2013 to 13.1% in 2015 (p<0.001). The increase was most noticeable among HIV-positive men (from 9.7% to 46.2%). Support for early treatment increased from 71.8% to 75.3% (p=0.02). Belief in TasP was associated with being HIV-positive, having a tertiary education, having recent condomless anal intercourse with casual male partners, and ever having taken post-exposure prophylaxis. Support for early HIV treatment was associated with being younger, living in New South Wales and being in paid employment. We recommend continued monitoring of the growing gap in belief about TasP between HIV-positive men and HIV-negative/untested men.

Awareness and knowledge of HIV pre-exposure prophylaxis among Australian gay and bisexual men: results of a national, online survey.

Background: Expanded access to HIV pre-exposure prophylaxis (PrEP) is being actively debated in Australia. Awareness and knowledge of this HIV-prevention method have not been assessed in detail in the primary affected population, gay and bisexual men. Methods: Awareness and knowledge of PrEP were assessed among Australian gay and bisexual men, who were asked to complete a national, anonymous, online survey in 2015. Associations with PrEP awareness were identified with multivariate logistic regression and associations with PrEP knowledge were identified using multivariate linear regression. Results: Among 1251 participants, 954 (77%) were aware of PrEP. The most common sources of information were gay community media, Australian websites and friends. Awareness of PrEP was independently associated with older age, living in a capital city, having a university degree, being tested for HIV, being HIV-positive, having condomless anal intercourse with regular male partners, and ever having taken post-exposure prophylaxis. Men in monogamous relationships were less likely to be aware of PrEP. Among men who were aware of PrEP, the mean PrEP knowledge score was 6.8 out of 13. Relatively few participants knew that taking PrEP involved regular clinical monitoring and that in Australia PrEP was only recommended for people at risk of HIV. Better knowledge was independently associated with living in a capital city, having a university degree, being in full-time employment, being HIV-positive, and ever having taken post-exposure prophylaxis or PrEP. Conclusions: To assist in appropriate PrEP uptake, we recommend educating gay and bisexual men about current Australian prescribing guidelines and how PrEP is accessed in Australia.