HIV and technology: the issue of prophylactic vaccines.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
S Kippax
Publications and source records attributed to S Kippax.
HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne.
OBJECTIVES: To investigate associations between gay men's optimism and sexual behaviour in the context of new HIV treatments. METHODS: Cross-sectional surveys (using anonymous, self-completed questionnaires) were conducted in Sydney during February 1998 (n = 2200) and in Melbourne during January 1998 (n = 1891). Gay men were recruited at social and sex-on-premises venues, clinics and fair days/carnivals. RESULTS: In a multivariate analysis, unprotected anal intercourse with casual partners (UAIC) was associated with being recruited at a sex-on-premises venue (rather than a clinic or fair day/carnival), HIV positivity, having been tested for HIV less than 6 months ago (rather than over 2 years ago or never having been tested), and not having a regular partner. Over and above these factors, UAIC was associated with agreement with the statements 'An HIV-positive person who is on combination therapy is unlikely to transmit HIV' and 'I'm less worried about HIV infection than I used to be'. CONCLUSIONS: The data reveal a significant relationship between UAIC and certain aspects of optimism in the context of new HIV treatments. Whereas the direction of causality cannot be specified, there is a clear need for HIV and sexual health education programmes to clarify issues of viral load, new and drug resistant strains of HIV, and other infectious agents.
Attitude↗
Sexual agreements between men in relationships.
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Disease Transmission, Infectious↗
Cultures of sexual adventurism as markers of HIV seroconversion: a case control study in a cohort of Sydney gay men.
A case control analysis within an ongoing cohort study was used to examine differences between seroconverters and men who remained HIV-negative. The cases were interviewed within one to 13 months prior to their seroconversion. Their responses to a structured questionnaire were compared with those of HIV-negative controls drawn from the same time period and from the same longitudinal study, Sydney Men and Sexual Health. Data collected from both cases and controls included: demographic and contextual variables, knowledge of HIV transmission, sexual practices, drug and alcohol use and attitudinal factors. The aim was to compare the sexual behaviours, and the social and cultural contexts of such behaviours, of men prior to their HIV seroconversion with men who did not seroconvert. Twenty-three men had seroconverted within the cohort. Cases were identified by a positive HIV antibody test or self-report of positive HIV status following a previous negative HIV test. Three-hundred-and-sixty-nine controls were selected on the basis of being HIV negative at interview in 1994, and having at least one subsequent medically-confirmed negative HIV antibody test. Univariate predictors of seroconversion were: being in a regular relationship with a known HIV-positive partner, drug use, and engaging in a range of anal and esoteric sexual practices. Practices commonly used to enhance sexual pleasure, such as group sex, watching and being watched having sex, the use of sex toys and dressing up/fantasy, were engaged in more frequently by seroconverters. Engaging in these esoteric sexual practices was highly correlated with drug use, involvement in the gay community and engagement in a wide range of anal practices. In the multivariate analysis independent predictors of seroconversion were: younger age; being in a regular relationship with a known HIV-positive partner; believing withdrawal to be safe with regard to HIV transmission; and range of esoteric practices. These results indicate the importance of the social and cultural contexts of particular sexual practices and consequent HIV transmission. Sexually adventurous men may be at increased risk for HIV because they seek sex within particular sexual sub-cultures.
Adult↗
AIDS impact.
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Acquired Immunodeficiency Syndrome↗
HIV-related discrimination: a survey of New South Wales general practitioners.
This study aimed to investigate the correlates of human immunodeficiency virus (HIV)-related discrimination among general practitioners. The survey, conducted in 1993-1994, covered a random sample of 878 general practitioners from six of the 12 New South Wales health areas, augmented by 44-general practitioners from the same areas who were antiretroviral drug prescribers. The response rate was 51 per cent, and the final usable sample was 451. Variables examined were: demographic characteristics, the number of HIV-infected patients, personal contact with people living with HIV or AIDS, personal contact with homosexuals, the degree of anxiety about HIV or AIDS, and the degree of HIV-related discrimination. Discriminatory attitudes among general practitioners decreased as contact with HIV-infected patients (P < 0.001), other people living with HIV or AIDS (P < 0.001), and homosexuals (P < 0.001) increased. Anxiety about HIV or AIDS also decreased as contact increased (P < 0.001). Higher levels of anxiety were strongly associated with higher levels of HIV-related discrimination (P < 0.001). The demographic correlates of discrimination among general practitioners were the same as those found in the wider population. The professional care of people living with HIV and AIDS was concentrated among a small number of general practitioners, many of whom were homosexual. Ten general practitioners were carrying extraordinarily high caseloads of over 200 HIV-infected patients each. Older, heterosexual and male general practitioners are an important target for education campaigns, and the professional care of people living with HIV or AIDS should be encouraged among a wider group of general practitioners.
Acquired Immunodeficiency Syndrome↗
Increase in unprotected anal intercourse with casual partners among Sydney gay men in 1996-98.
We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly with a view to investigating any behavioural changes after the recent improvements in antiretroviral therapies. Trends in unprotected anal intercourse were monitored through the Sydney Gay Community Periodic (cross-sectional) Surveys which were conducted at six-monthly intervals between February 1996 and February 1998. Gay men (n = 2,863) were recruited and self-completed a short questionnaire at three gay venues and a sexual health clinic. There was a significant increase in unprotected anal intercourse with casual partners (but not with regular partners), applicable to both HIV positive and HIV negative men. Sexual practice was generally unrelated to ideas about recent advances in viral load testing and combination therapies.
Adult↗
Gay men who engage repeatedly in unprotected anal intercourse with casual partners: the Sydney Men and Sexual Health Study.
We set out to determine the frequency and correlates of gay men's repeated unprotected anal intercourse with casual partners (UAI-C), defined as UAI-C reported at each of 3 annual interviews. By May 1997, 659 men had completed 3 annual interviews for the Sydney Men and Sexual Health (SMASH) cohort study. For the 3 6-month periods prior to each interview, 127 men reported UAI-C during one period only; 45 reported it during 2 periods; and 20 men reported it during all 3 periods. These 20 men who had repeated UAI-C were compared with 497 men who had anal intercourse with casual partners but did not report on all 3 occasions that they had UAI-C. Logistic regression revealed that repeated UAI-C was associated with HIV-positive status, more casual partners, less favourable attitudes toward condoms and greater recreational drug use. Few gay men have repeated UAI-C but those who do run greater risk of HIV transmission.
Adult↗
Secrecy, disclosure, and closet dynamics.
This paper examines the assumption that male homosexuality has a natural affinity with femininity and that male heterosexuality has a natural affinity with masculinity. An analysis of the relationship between people's disclosure or concealment of their homosexual practice or identity, particularly as it relates to notions of hegemonic masculinity and femininity provides the focus of this paper. It is argued that everyday understandings of homosexuality tend to be resolved in such as way as to press homosexuality into the service of privileging a male, masculine, and heterosexual subjectivity. This privileging is achieved, in part, as a result of the everyday social practices of homosexually active men's witting and unwitting deference to the hegemonic presumption that masculine men are naturally heterosexual, and its inverse, that feminine men are homosexual and are a perturbation of the natural order. We argue that this correlation is manufactured in everyday life in the world of appearances, but that the appearance of things is not reflected at a level of practice, which is to say, male homosexual practice is not necessarily feminine, just as male heterosexual practice is not necessarily masculine. Realities that conflict with the hegemonic realities are masked in the public world, for a variety of reasons. What we have called closet dynamics are the various discourses through which homosexuality is concealed and disclosed, and the various subject positions people take up in relation to those discourses.
Gender Identity↗
"Semi-straight sort of sex": class and gay community attachment explored within a framework of older homosexually active men.
Gay Community Attachment has proved a significant predictor of successful behavior change among gay-identifying men in response to HIV/AIDS. Related work at Macquarie University, Sydney, Australia, indicated that attachment to gay community is not a simple issue; rather, complex issues of sexual identity formation, the constraints of social inequality and localized sexual cultures inhibit the process of attachment and, therefore, successful HIV prevention. This paper discusses some of the findings from close-focus (qualitative) research on older homosexually active men which explore in depth the dynamic whereby these men attached themselves to gay community in terms of an analysis of class, generation, and the interplay with self-construction and masculinity.
Adult↗
Infection control and HIV-related discrimination and anxiety. Glove use during venipuncture.
OBJECTIVE: Reports into HIV-related discrimination reveal continuing concerns about the behaviour of health care workers, particularly with reference to practices such as excessive or selective infection control. This study examines whether the selective adoption of an infection control procedure (using gloves during venipuncture) is related to discriminatory attitudes, anxiety about HIV/AIDS and the degree of contact with HIV-infected patients. METHOD: In 1993 and 1994, 451 general practitioners (GPs) were surveyed in six of the 12 New South Wales Health Areas and Regions. The sample included 49 anti-retroviral prescribers. GPs were presented with six patient scenarios and asked with whom they would use gloves during venipuncture. RESULTS: 41.9% of GPs reported that they would selectively use gloves, and generally targeted the homosexual patient only, or combinations of patients that included the homosexual man. GPs revealed poor compliance with universal precautions, as only 37.5% reported that they would use gloves with all of the six patients. Intended glove use was significantly related to HIV-related discrimination (p < 0.0001) and anxiety about HIV/AIDS (p < 0.0001). GPs who selectively chose to use gloves had the highest discrimination and anxiety scores; GPs who chose not to use gloves with any of the patients had the lowest discrimination and anxiety scores, and were more likely to work in HIV medicine. Except for differences in Health Area, this study did not identify any factors that helped to explain which GPs consistently followed universal precautions. CONCLUSION: This study demonstrates that selective infection control is related to discriminatory attitudes and anxiety about HIV/AIDS. GPs can avoid a discriminatory practice by consistently following universal precautions. More research is needed to identify the factors that promote good infection control practices.
Acquired Immunodeficiency Syndrome↗
Sexual negotiation in the AIDS era: negotiated safety revisited.
OBJECTIVE: To test the safety of the 'negotiated safety' strategy-the strategy of dispensing with condoms within HIV-seronegative concordant regular sexual relationships under certain conditions. METHOD: Data from recently recruited cohort of homosexually active men (Sydney Men and Sexual Health cohort, n = 1037) are used to revisit negotiated safety. The men were surveyed using a structured questionnaire and questions addressing their sexual relationships and practice their own and their regular partner's serostatus, agreements entered into by the men concerning sexual practice within and outside their regular relationship, and contextual and demographic variables. RESULTS: The findings indicate that a significant number of men used negotiated safety as an HIV prevention strategy. In the 6 months prior to interview, of the 181 men in seroconcordant HIV-negative regular relationships, 62% had engaged in unprotected anal intercourse within their relationship, and 91% (165 men) had not engaged in unprotected anal intercourse outside their relationship. Of these 165 men, 82% had negotiated agreements about sex outside their relationship. The safety of negotiation was dependent not only on seroconcordance but also on the presence of an agreement; 82% of the men who had not engaged in unprotected anal intercourse outside their regular relationship had entered into an agreement with their partner, whereas only 56% of those who had engaged in unprotected anal intercourse had an agreement. The safety of negotiation was also related to the nature of the safety agreement reached between the men and on the acceptability of condoms. Agreements between HIV-negative seroconcordant regular partners prohibiting anal intercourse with casual partners or any form of sex with a casual partner were typically complied with, and men who had such negotiated agreements were at low risk of HIV infection. CONCLUSIONS: The adoption of the strategy of negotiated safety among men in HIV-seronegative regular relationships may help such men sustain the safety of their sexual practice.
Adolescent↗
Sexual practices in a broad cross-sectional sample of Sydney gay men.
The aim of this study was to provide current data on the sexual practices in a broad cross-sectional sample of gay and homosexually active men in Sydney. Anonymous, short questionnaires were completed by 1611 gay men recruited at the 1996 Gay and Lesbian Mardi Gras Fair Day or at one of six venues (including two sexual health centres) across the metropolitan area during the following week. The sample was diverse, but the men tended to be of Anglo-Australian background, well educated, professionally employed, attached to gay community and gay identified. They mainly had sex with other men rather than with men and women. Most (86.0 per cent) had been tested for human immunodeficiency virus. Excluding 241 men recruited in sexual health centres, 11.2 per cent were HIV-positive and 73.4 per cent were negative. Where it occurred in regular relationships, unprotected anal intercourse was usually between seroconcordant partners (78.5 per cent). Unprotected anal intercourse between discordant or nonconcordant regular partners was much less common, and in about half the cases involved withdrawal prior to ejaculation exclusively rather than ejaculation inside. Almost 12 per cent of the men had at least 'occasionally' engaged in unprotected anal intercourse with a casual partner in the previous six months, with approximately half of these men having adopted a withdrawal strategy on every occasion. We conclude that short surveys can provide valuable and timely data on sexual practices in a broad cross-sectional sample of gay and homosexually active men. Key messages for those involved in gay men's education are the high rates of unprotected anal intercourse between casual partners and the extensive practice of withdrawal.
Adolescent↗
Sexuality education and young people's sexual behavior: a review of studies.
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Acquired Immunodeficiency Syndrome↗
No relationship between age and HIV risk behaviour among Sydney gay men.
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Adult↗
Social-cultural aspects. Vancouver Conference Review.
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Adolescent↗
Gay youth and their precautionary sexual behaviors: the Sydney men and sexual health study.
Many commentators have positioned Western gay youth as a high-risk group for HIV infection and obscured important cultural, social, and contextual differences between populations. This study compares risk of HIV transmission factors among 216 young (under 25 years) and 822 older (25 years or over) homosexually active men, recruited through Sydney gay community and other sources. Bivariate and multivariate analyses of survey data that were collected by personal interviews consistently supported our hypothesis of no difference in HIV-related risk factors between young and older men. Although young men in this cohort were more likely to be of unknown serostatus, they were at least as knowledgeable, as attached to gay community, and as precautionary in their sexual behaviors with regular and casual male partners as their older counterparts. Safety campaigns targeting these young gay men should focus, for example, on their lower rates of HIV antibody testing and not be based on a false premise of hedonistic, uninformed, and disenfranchised youth.
AIDS Serodiagnosis↗
HIV prevention in developed countries.
HIV prevention in developed countries is marked by impressive successes and dismal failures. The successes point the way to what works; the failures highlight obstacles that must be overcome. Successes include important behavioural changes among gay and bisexual men, antiviral use to prevent vertical transmission, and securing the safety of the blood supply. New strategies are needed to reach the residual of individuals continuing with unsafe practices (a special hazard in high-prevalence areas); to reach young people who are beginning to engage in sexual relations and injection drug use; and to overcome political opposition to prevention strategies.
Acquired Immunodeficiency Syndrome↗