AIDS and Behavior

, Volume 22, Issue 11, pp 3617–3626 | Cite as

Comfort Relying on HIV Pre-exposure Prophylaxis and Treatment as Prevention for Condomless Sex: Results of an Online Survey of Australian Gay and Bisexual Men

  • Martin HoltEmail author
  • Bridget L. Draper
  • Alisa E. Pedrana
  • Anna L. Wilkinson
  • Mark Stoové
Original Paper


HIV-negative and untested gay and bisexual men from Victoria, Australia (n = 771) were surveyed during August–September 2016 about their comfort having condomless sex with casual male partners in scenarios in which pre-exposure prophylaxis (PrEP) or treatment as prevention were used. Men not using PrEP were most comfortable with the idea of condomless sex with HIV-negative partners (31%), followed by partners using PrEP (23%). PrEP users were more comfortable with the idea of condomless sex with these partner types (64 and 72%, respectively). Very few men not taking PrEP were comfortable with condomless sex with HIV-positive partners (3%), even with undetectable viral loads (6%). PrEP users were more comfortable with condomless sex with HIV-positive partners (29%), and those with undetectable viral loads (48%). Being on PrEP, having recent condomless sex with casual partners or a HIV-positive regular partner were independently associated with comfort having condomless sex.


Attitudes Condoms Diffusion of innovations theory HIV treatment Men who have sex with men Pre-exposure prophylaxis 



We thank all the gay and bisexual men who participated in the study. We also thank Jason Asselin for his contributions to survey design and data management.


The Victorian Department of Health provided funding for this research. The Centre for Social Research in Health receives funding from the Australian Government Department of Health. The Burnet Institute receives funding from the Victorian Department of Health for surveillance projects. Mark Stoové was supported by a National Health and Medical Research Council (NHMRC) Career Development Fellowship and Research Fellowship. Alisa Pedrana was supported by a NHMRC Early Career Fellowship. No pharmaceutical grants were received for this study.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

All procedures were in accordance with the ethical standards of the Alfred Health Human Research Ethics Committee (Project 62/16) and the National Health and Medical Research Council (Australia).

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed. Geneva: World Health Organization; 2016.Google Scholar
  2. 2.
    Commonwealth of Australia. Seventh National HIV Strategy 2014–2017. Canberra: Australian Government Department of Health; 2014.Google Scholar
  3. 3.
    NSW Ministry of Health. NSW HIV strategy 2016–2020. Sydney: NSW Health; 2015.Google Scholar
  4. 4.
    United front to expand PrEP in Queensland [press release]. Brisbane: Queensland Government, 12th February 2016.Google Scholar
  5. 5.
    One step closer to eliminating HIV [press release]. Melbourne: State Government of Victoria, 30th January 2016.Google Scholar
  6. 6.
    The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2016. Sydney: The Kirby Institute, UNSW Australia; 2016.Google Scholar
  7. 7.
    Holt M, Lea T, Schmidt HM, Kolstee J, Ellard J, Murphy D, et al. Willingness to use and have sex with men taking HIV pre-exposure prophylaxis (PrEP): results of online surveys of Australian gay and bisexual men, 2011–15. Sex Transm Infect. 2017;93(6):438–44.CrossRefGoogle Scholar
  8. 8.
    Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, et al. Australasian society for HIV, viral hepatitis and sexual health medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad. 2017;3(3):168–84.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Holt M, Lea T, Mao L, Zablotska I, Lee E, Hull P, et al. Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys. Sex Health. 2017;14(1):72–9.CrossRefGoogle Scholar
  10. 10.
    Holt M. Progress and challenges in ending HIV and AIDS in Australia. AIDS Behav. 2017;21(2):331–4.CrossRefGoogle Scholar
  11. 11.
    Holt M. HIV pre-exposure prophylaxis and treatment as prevention: a review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas. Sex Health. 2014;11(2):166–70.CrossRefGoogle Scholar
  12. 12.
    Young I, McDaid L. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV? A review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS Behav. 2014;18(2):195–216.CrossRefGoogle Scholar
  13. 13.
    Holt M, Lea T, Schmidt HM, Murphy D, Rosengarten M, Crawford D, et al. Increasing belief in the effectiveness of HIV treatment as prevention: results of repeated, national surveys of Australian gay and bisexual men, 2013–15. AIDS Behav. 2016;20(7):1564–71.CrossRefGoogle Scholar
  14. 14.
    Bavinton BR, Holt M, Grulich AE, Brown G, Zablotska IB, Prestage GP. Willingness to act upon beliefs about ‘treatment as prevention’ among Australian gay and bisexual men. PLoS ONE. 2016;11(1):e0145847.CrossRefGoogle Scholar
  15. 15.
    Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.CrossRefGoogle Scholar
  16. 16.
    Weinstein ND, Sandman PM, Blalock SJ. The precaution adoption process model. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research and practice. 4th ed. San Francisco: Jossey-Bass; 2008. p. 123–47.Google Scholar
  17. 17.
    Bertrand JT. Diffusion of Innovations and HIV/AIDS. J Health Commun. 2004;9(sup1):113–21.CrossRefGoogle Scholar
  18. 18.
    Rogers E. Diffusion of innovations. 3rd ed. New York: The Free Press; 1983.Google Scholar
  19. 19.
    Mao L, Adam P, Kippax S, Holt M, Prestage G, Calmette Y, et al. HIV-negative gay men’s perceived HIV risk hierarchy: imaginary or real? AIDS Behav. 2013;17(4):1362–9.CrossRefGoogle Scholar
  20. 20.
    Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV pre-exposure prophylaxis (PrEP) for all populations: a systematic review and meta-analysis. AIDS. 2016;30(12):1973–83.CrossRefGoogle Scholar
  21. 21.
    Kennedy CE, Bernard LJ, Muessig KE, Konda KA, Akl EA, Lo Y-R, et al. Serosorting and HIV/STI infection among HIV-negative MSM and transgender people: a systematic review and meta-analysis to inform WHO guidelines. J Sex Transm Dis. 2013;2013:8.Google Scholar
  22. 22.
    Montaño DE, Kasprzyk D. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: theory, research and practice. 4th ed. San Francisco: Jossey-Bass; 2008. p. 67–96.Google Scholar
  23. 23.
    Lee E, Mao L, Lea T, McKenzie T, Batrouney C, Allan B, et al. Gay community periodic survey: Melbourne 2017. Sydney: Centre for Social Research in Health, UNSW Australia; 2017.Google Scholar
  24. 24.
    Pedrana A, Hellard M, Guy R, El-Hayek C, Gouillou M, Asselin J, et al. Stop the Drama Downunder: a social marketing campaign increases HIV/sexually transmitted infection knowledge and testing in Australian gay men. Sex Transm Dis. 2012;39(8):651–8.CrossRefGoogle Scholar
  25. 25.
    Wilkinson AL, Pedrana AE, El-Hayek C, Vella AM, Asselin J, Batrouney C, et al. The impact of a social marketing campaign on HIV and sexually transmissible infection testing among men who have sex with men in Australia. Sex Transm Dis. 2016;43(1):49–56.CrossRefGoogle Scholar
  26. 26.
    Chatfield M, Mander A. The Skillings-Mack test (Friedman test when there are missing data). Stata J. 2009;9(2):299–305.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Hull P, Mao L, Kolstee J, Duck T, Feeney L, Prestage G, et al. Gay community periodic survey: Sydney 2016. Sydney: Centre for Social Research in Health, UNSW Australia; 2016.Google Scholar
  28. 28.
    Lee E, Mao L, McKenzie T, Batrouney C, West M, Prestage G, et al. Gay community periodic survey: Melbourne 2016. Sydney: Centre for Social Research in Health, UNSW Australia; 2016.Google Scholar
  29. 29.
    Holt M, Lea T, Kippax S, Kolstee J, Ellard J, Velecky M, et al. Awareness and knowledge of HIV pre-exposure prophylaxis among Australian gay and bisexual men: results of a national, online survey. Sex Health. 2016;13(4):359–65.CrossRefGoogle Scholar
  30. 30.
    Hojilla JC, Koester KA, Cohen SE, Buchbinder S, Ladzekpo D, Matheson T, et al. Sexual behavior, risk compensation, and HIV prevention strategies among participants in the San Francisco PrEP demonstration project: a qualitative analysis of counseling notes. AIDS Behav. 2016;20(7):1461–9.CrossRefGoogle Scholar
  31. 31.
    Murphy D. Early experience of PrEP in Australia. In: Mao L, Adam P, Treloar C, de Wit J, editors. Annual report of trends in behaviour: HIV/AIDS, hepatitis and sexually transmissible infections in Australia 2016. Sydney: UNSW Australia; 2016. p. 27–8.Google Scholar
  32. 32.
    Koester K, Amico RK, Gilmore H, Liu A, McMahan V, Mayer K, et al. Risk, safety and sex among male PrEP users: time for a new understanding. Cult Health Sex. 2017;19(12):1301–13.CrossRefGoogle Scholar
  33. 33.
    Huebner DM, Rebchook GM, Kegeles SM. A longitudinal study of the association between treatment optimism and sexual risk behavior in young adult gay and bisexual men. J Acquir Immune Defic Syndr. 2004;37(4):1514–9.CrossRefGoogle Scholar
  34. 34.
    Persson A, Ellard J, Newman CE. Bridging the HIV divide: stigma, stories and serodiscordant sexuality in the biomedical age. Sex Cult. 2016;20(2):197–213.CrossRefGoogle Scholar
  35. 35.
    Smith AMA, Rissel CE, Richters J, Grulich AE, de Visser RO. Sex in Australia: sexual identity, sexual attraction and sexual experience among a representative sample of adults. Aust N Z J Public Health. 2003;27(2):138–45.CrossRefGoogle Scholar
  36. 36.
    Rehle T, Lazzari S, Dallabetta G, Asamoah-Odei E. Second-generation HIV surveillance: better data for decision-making. Bull World Health Organ. 2004;82(2):121–7.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Social Research in HealthUNSWSydneyAustralia
  2. 2.The Burnet InstituteMelbourneAustralia
  3. 3.School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  4. 4.Department of Nutrition, Harvard School of Public HealthHarvard UniversityCambridgeUSA

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