Centre for Social Research in Health.
The Kirby Institute, UNSW Sydney.
AIDS. 2021 Apr 1;35(5):835-840. doi: 10.1097/QAD.0000000000002797.
To assess trends in HIV prevention strategies among Australian gay and bisexual men (GBM) since the introduction of preexposure prophylaxis (PrEP), the level of net prevention coverage (the use of safe strategies), and the characteristics of HIV-negative and untested GBM who remain at risk of HIV.
Repeated behavioural surveillance of GBM recruited from venues, events and online in seven Australian states and territories.
Participants with casual male partners were included. Trends in sexual practices, prevention strategies, net prevention coverage and the characteristics of 'at risk' participants were assessed with binary and multivariate logistic regression.
A total of 32 048 survey responses (2014-2019) were included. The proportion of participants who reported consistent condom use declined (44.6-23.2%). The proportion who reported any condomless anal intercourse with casual partners increased (37.4-62.0%) but net prevention coverage also increased (68.1-74.9%), with higher levels of undetectable viral load among HIV-positive participants and rapidly increasing PrEP use by HIV-negative participants. PrEP became the most commonly reported prevention strategy in 2019 (31.1%). The analysis of 'at risk' participants showed that they became more likely to report frequent condomless anal intercourse with casual partners but had fewer partners and more partners with undetectable viral load or on PrEP. 'At risk' participants became more likely to identify as bisexual and to be born overseas.
There has been a rapid, historic shift in HIV prevention among GBM in Australia. Net prevention coverage has increased among GBM and 'at risk' GBM have become less at risk of HIV, facilitating reductions in HIV transmission.
评估澳大利亚男同性恋和双性恋者（GBM）自暴露前预防（PrEP）引入以来 HIV 预防策略的趋势、净预防覆盖率（安全策略的使用）水平，以及仍处于 HIV 风险中的 HIV 阴性和未经检测的 GBM 的特征。
在澳大利亚七个州和地区的场所、活动和在线上招募 GBM 进行重复行为监测。
纳入有偶然男性伴侣的参与者。使用二项和多变量逻辑回归评估性行为、预防策略、净预防覆盖率以及“有风险”参与者的特征的趋势。
共纳入 32048 份调查回复（2014-2019 年）。报告坚持使用安全套的参与者比例下降（44.6-23.2%）。报告与偶然伴侣发生任何无保护肛交的参与者比例增加（37.4-62.0%），但净预防覆盖率也增加（68.1-74.9%），HIV 阳性参与者的病毒载量不可检测比例较高，HIV 阴性参与者的 PrEP 使用迅速增加。2019 年 PrEP 成为最常报告的预防策略（31.1%）。对“有风险”参与者的分析表明，他们更有可能报告与偶然伴侣频繁发生无保护肛交，但伴侣数量减少，且更多伴侣的病毒载量不可检测或接受 PrEP 治疗。“有风险”参与者更有可能自我认同为双性恋，且出生在海外。
澳大利亚 GBM 的 HIV 预防发生了迅速而具有历史意义的转变。GBM 和“有风险”GBM 的净预防覆盖率都有所增加，且“有风险”GBM 感染 HIV 的风险降低，促进了 HIV 传播的减少。
