Biomedical HIV prevention: Implications for the sexual practices and relationships of gay and bisexual men
Biomedical HIV prevention may significantly decrease HIV incidence among gay and bisexual men (GBM), but understanding its relationships with sexual, relational and community contexts is required to maximise effectiveness. The objective of this thesis is to examine emerging biomedical HIV prevention strategies in terms of behavioural and psychosocial contextual factors relevant to GBM, with a particular focus on regular sexual relationships. The first project identified that Australian GBM were likely to increase their frequency of HIV testing if home self-testing was available. The second project examined characteristics of HIV serodiscordant and seroconcordant relationships, prospective rates of relationship break-up, and HIV incidence in HIV-negative men in homosexual male serodiscordant couples. HIV incidence among HIV-negative men with HIV-positive regular partners was highest in the first year of the relationship. The third project explored attitudes and knowledge about treatment as prevention (TasP) and willingness of Australian GBM to act upon their beliefs. A minority of men reported willingness to have condomless sex with an opposite-status sexual partner when the HIV-positive partner was on treatments; those more willing tended to engage in higher risk practices. The fourth and fifth projects were analyses of regular partnerships among Australian GBM, demonstrating that diverse partnership types, practices, and HIV risks exist within the overarching category of regular partner . The sixth project explored HIV prevention strategies used by homosexual male serodiscordant couples, showing that when accounting for a range of risk reduction strategies, only a small proportion of acts of anal intercourse were high risk for transmission. The research in this thesis highlights the complexities of incorporating biomedical prevention into existing strategies. HIV prevention needs to be viewed in context to gain a better understanding of: sexual partnerships, both casual and regular; impacts of biomedical prevention on HIV risk and behaviour; attitudes, beliefs and knowledge about new and traditional forms of HIV prevention; how HIV community education needs to adapt; and the HIV research implications arising from the new prevention environment.
Men who have sex with men, HIV prevention, Treatment as prevention, Sexual relationships
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