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Gay Men’s Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data

Abstract

Using repeated, cross-sectional behavioural surveillance data from Australia, we assessed trends in relationship agreements and casual sex among HIV-negative and untested gay and bisexual men who had regular partners during 2013–2018. We conducted three analyses: (i) trends in relationship agreements and casual sex over time; (ii) bivariate comparisons of PrEP users and non-PrEP-users to identify factors associated with PrEP use; and (iii) multivariate logistic regression to identify factors independently associated with PrEP use. The analysis of trends over time included 21,593 men, from which a sub-sample (n = 3764) was used to compare PrEP users and non-PrEP-users. We found a large increase in agreements that allowed condomless sex with casual partners, particularly by PrEP users in relationships (nearly 40% of whom had such an agreement). A further 34% of PrEP users reported having casual condomless sex without an agreement that permitted that behaviour, while 13% of non-PrEP-users also reported condomless sex with casual partners without an agreement. PrEP use was independently associated with having agreements permitting condomless sex with casual partners, recent condomless sex with casual partners, having greater numbers of male partners, recent post-exposure prophylaxis use, having an HIV-positive regular male partner, and recent condomless sex with regular male partners. Our findings show a shift away from relationship agreements in which condomless sex was only sanctioned between regular partners.

Resumen

Utilizando datos de encuestas repetidas y transversales de Australia, evaluamos las tendencias relacionadas con los acuerdos de exclusividad sexual y el sexo casual entre hombres gays y bisexuales VIH-negativos y no probados que tuvieron parejas regulares durante 2013–2018. Realizamos tres análisis: (i) análisis de tendencias temporales en los acuerdos de exclusividad sexual y el sexo casual; (ii) análisis bivariante comparando participantes que usan PrEP versus los que no lo usan para identificar los factores asociados con el uso de PrEP; y (iii) regresión logística multi-variable para identificar los factores independientes asociados con el uso de PrEP. El análisis de las tendencias sobre el tiempo incluyó 21 593 hombres, de los cuales usamos una submuestra (n=3764) para comparar participantes que usan PrEP versus los que no lo usan. Encontramos un gran aumento de acuerdos que permitían el sexo sin condón con parejas casuales, particularmente por parte de participantes en las relaciones que usan PrEP (casi el 40% de los cuales tenían dicho acuerdo). Otro 34% de participantes que usan PrEP informaron que tuvieron sexo sin condón sin un acuerdo que permitiera ese comportamiento, mientras que el 13% de personas que no usan PrEP también informaron que tuvieron sexo sin condón con parejas casuales sin un acuerdo. Los usuarios de PrEP eran más activos sexualmente y reportaron prácticas sexuales de mayor riesgo. Nuestros hallazgos muestran un cambio de los acuerdos de exclusividad en los que el sexo sin condón solo se sancionaba entre parejas habituales.

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Notes

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    https://csrh.arts.unsw.edu.au/research/publications/gcps/.

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Acknowledgements

The Centre for Social Research in Health and the Kirby Institute are supported by the Australian Government Department of Health. The GCPS are funded by state and territory health departments. JM is in receipt of an Australian Government Research Training Program Scholarship. BB is supported by a National Health and Medical Research Council Early Career Fellowship. No pharmaceutical grants were received for this research.

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MH, TM, EL, LM, BB and GP designed this study and oversaw the collection of the data. JM drafted the manuscript and conducted the quantitative analyses, supported by BB, KD and MH. All authors reviewed and commented on several versions of the manuscript and agreed with the final version.

Corresponding author

Correspondence to James MacGibbon.

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The Centre for Social Research in Health and the Kirby Institute are supported by the Australian Government Department of Health. The funding source did not have any involvement in the collection, analysis and interpretation of data, or in the writing of this manuscript and decision to submit for publication.

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MacGibbon, J., Broady, T., Drysdale, K. et al. Gay Men’s Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data. AIDS Behav 24, 1389–1399 (2020). https://doi.org/10.1007/s10461-019-02737-9

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Keywords

  • HIV prevention
  • Biomedical technologies
  • Gay and bisexual men
  • Relationship agreements
  • Negotiated safety