Skip to main content
SpringerLink
Log in

Changes in Sexual Behaviour Following PrEP Initiation Among Australian Gay and Bisexual Men in Relationships: Results from a Prospective Observational Study

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Few studies have examined changes in sexual behaviour following HIV pre-exposure prophylaxis (PrEP) initiation among gay, bisexual and other men who have sex with men (GBM) in relationships. In a national, online, prospective study of GBM in Australia, we compared sexual behaviours prior to and after PrEP initiation among HIV-negative and unknown-HIV-status men (recruited 2014–2017) not taking PrEP at baseline and who completed at least one six-monthly follow-up by July 2018. Among men in relationships who did not initiate PrEP (n = 339), we compared their most recent survey to their prior one, while among men in relationships who initiated PrEP (n = 81), we compared follow-ups before and after PrEP initiation. Among the 81 PrEP-initiators who were in a relationship both before and after initiation, the proportion reporting their regular partner was on PrEP increased from 8.3 to 44.4% (p < 0.001) and the proportion reporting receptive CLAIC increased from 27.2 to 44.4% (p = 0.009). Overall, men who initiated PrEP were more likely to be in a relationship with a partner on PrEP, and it appeared they started PrEP around the same time. Receptive CLAIC also became more common.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018. Sydney: Kirby Institute, UNSW Sydney; 2018.

    Google Scholar 

  2. Jin F, Crawford J, Prestage GP, Zablotska I, Imrie J, Kippax SC, et al. HIV risk reduction behaviours in gay men: unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men. AIDS. 2009;23(2):243.

    Article  Google Scholar 

  3. Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30(12):1973–83.

    Article  Google Scholar 

  4. Grulich AE, Guy R, Amin J, Jin F, Selvey C, Holden J, et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV. 2018;5(11):e629–37.

    Article  Google Scholar 

  5. Public Health England. Trends in new HIV diagnoses and in people receiving HIV-related care in the United Kingdom: data to the end of december 2018. Health Prot Rep. 2019;13(31):1–8.

    Google Scholar 

  6. Holt M, Lea T, Mao L, Kolstee J, Zablotska I, Duck T, et al. Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013–17. Lancet HIV. 2018;5(8):e448–556.

    Article  Google Scholar 

  7. Bavinton BR, Grulich AE, Broady T, Keen P, Mao L, Patel P, et al. Increases in HIV testing frequency in Australian gay and bisexual men are concentrated among PrEP users: an analysis of Australian behavioural surveillance data, 2013–18. AIDS Behav. 2020;24:2691–702.

    Article  Google Scholar 

  8. Australian Government Department of Health. Eighth National HIV strategy, 2018–2022. Canberra: Australian Government Department of Health; 2018.

    Google Scholar 

  9. Australian Government Department of Health. Schedule of pharmaceutical benefits: summary of changes effective 1 april 2018. Canberra: Pharmaceutical Benefits Scheme, Australian Government Department of Health; 2018.

    Google Scholar 

  10. Kirby Institute. Monitoring HIV Pre-exposure Prophylaxis Uptake in Australia (Issue 2). Sydney: Kirby Institute, UNSW Sydney; 2019.

    Google Scholar 

  11. Broady T, Power C, Mao L, Bavinton BR, Chan C, Bambridge C, et al. Gay community periodic survey: Sydney 2019. Sydney: Centre for Social Research in Health, UNSW Sydney; 2019.

    Google Scholar 

  12. Broady T, Mao L, Bavinton BR, McKenzie T, Batrouney C, Burnett C, et al. Gay community periodic survey: Melbourne 2019. Sydney: Centre for Social Research in Health, UNSW Sydney; 2019.

    Google Scholar 

  13. Prestage GP, Maher L, Grulich AE, Bourne A, Hammoud MA, Vaccher S, et al. Changes in behavior following PrEP initiation among Australian gay and bisexual men. J Acquir Immun Def Synd. 2019;81(1):52–6.

    Article  Google Scholar 

  14. Lal L, Audsley J, Murphy DA, Fairley CK, Stoove M, Roth N, et al. Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users. AIDS. 2017;31(12):1709–14.

    Article  Google Scholar 

  15. Newcomb ME, Moran K, Feinstein BA, Forscher E, Mustanski B. Pre-exposure prophylaxis (PrEP) use and condomless anal sex: evidence of risk compensation in a cohort of young men who have sex with Men. J Acquir Immun Def Synd. 2018;77(4):358–64.

    Article  Google Scholar 

  16. Hoornenborg E, Coyer L, van Laarhoven A, Achterbergh R, de Vries H, Prins M, et al. Change in sexual risk behaviour after 6 months of pre-exposure prophylaxis use: results from the Amsterdam pre-exposure prophylaxis demonstration project. AIDS. 2018;32(11):1527–32.

    Article  Google Scholar 

  17. Hammoud MA, Vaccher S, Jin F, Bourne A, Maher L, Holt M, et al. HIV pre-exposure prophylaxis (PrEP) uptake among gay and bisexual men in Australia and factors associated with the non-use of PrEP among eligible men: results from a prospective cohort study. J Acquir Immun Def Synd. 2019;81(3):e73–84.

    Article  Google Scholar 

  18. Kippax S, Slavin S, Ellard J, Hendry O, Richters J, Grulich A, et al. Seroconversion in context. AIDS Care. 2003;15(6):839–52.

    Article  CAS  Google Scholar 

  19. Volk JE, Prestage G, Jin F, Kaldor J, Ellard J, Kippax S, et al. Risk factors for HIV seroconversion in homosexual men in Australia. Sex Health. 2006;3(1):45–51.

    Article  Google Scholar 

  20. Down I. Building intimacy, managing risk: gay mens relationships and HIV. HIV Aust. 2014;12(1):7.

    Google Scholar 

  21. Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five US cities. AIDS. 2009;23(9):1153–62.

    Article  Google Scholar 

  22. Goodreau SM, Carnegie NB, Vittinghoff E, Lama JR, Sanchez J, Grinsztejn B, et al. What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE. 2012;7(11):e50522.

    Article  CAS  Google Scholar 

  23. Xiridou M, Geskus R, de Wit J, Coutinho R, Kretzschmar M. The contribution of steady and casual partnerships to the incidence of HIV infection among homosexual men in Amsterdam. AIDS. 2003;17(7):1029–38.

    Article  Google Scholar 

  24. Holt M, Lea T, Schmidt H-M, 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, 2011–2015. Sex Transm Infect. 2017;93(6):438–44.

    Article  Google Scholar 

  25. Mitchell JW, Stephenson R. HIV-Negative partnered men’s willingness to use pre-exposure prophylaxis and associated factors among an internet sample of US HIV-negative and HIV-discordant male couples. LGBT Health. 2015;2(1):35–40.

    Article  Google Scholar 

  26. John SA, Robles G, Starks TJ, Rendina HJ. Differences between groups of pre-exposure prophylaxis (PrEP) using couples in HIV-negative/unknown relationships. J Acquir Immun Def Synd. 2019;81(4):419–28.

    Article  Google Scholar 

  27. Bavinton BR, Prestage GP, Jin F, Phanuphak N, Grinsztejn B, Fairley CK, et al. Strategies used by gay male HIV serodiscordant couples to reduce the risk of HIV transmission from anal intercourse in three countries. J Int AIDS Soc. 2019;22(4):e25277.

    Article  Google Scholar 

  28. MacGibbon J, Broady T, Drysdale K, Bavinton B, Lee E, Mao L, et al. Gay Men’s relationship agreements in the era of pre-exposure prophylaxis: an analysis of Australian behavioural surveillance data. AIDS Behav. 2019;24:1389–99.

    Article  Google Scholar 

  29. Hammoud MA, Jin F, Degenhardt L, Lea T, Maher L, Grierson J, et al. Following lives undergoing change (flux) study: profile of an online cohort of drug use among gay and bisexual men in Australia. Int J Drug Policy. 2017;41:41–50.

    Article  Google Scholar 

  30. Mao L, Crawford J, Van De Ven P, Prestage G, Grulich A, Kaldor J, et al. Differences between men who report frequent, occasional or no unprotected anal intercourse with casual partners among a cohort of HIV-seronegative gay men in Sydney Australia. AIDS Care. 2006;18(8):942–51.

    Article  CAS  Google Scholar 

  31. Holt M, Lea T, Bear B, Halliday D, Ellard J, Murphy D, et al. Trends in attitudes to and the use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011–2017: implications for further implementation from a diffusion of innovations perspective. AIDS Behav. 2019;23(7):1939–50.

    Article  Google Scholar 

  32. Holt M, Broady TR, Mao L, Chan C, Rule J, Ellard J, et al. Increasing pre-exposure prophylaxis use and “net prevention coverage” in behavioural surveillance of australian gay and bisexual men, 2014–19. AIDS. 2021. https://doi.org/10.1097/qad.0000000000002797.

    Article  PubMed  Google Scholar 

  33. Kippax S. Negotiated safety agreements among gay men beyond condoms. Boston: Springer; 2002. p. 1–15.

    Google Scholar 

  34. 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.

    Article  Google Scholar 

  35. Bavinton BR, Duncan D, Grierson J, Zablotska IB, Down IA, Grulich AE, et al. The meaning of ‘regular partner’ in HIV research among gay and bisexual men: implications of an Australian cross-sectional survey. AIDS Behav. 2016;20(8):1777–84.

    Article  Google Scholar 

  36. Bavinton BR, Brown G, Hurley M, Bradley J, Keen P, Conway DP, et al. Which gay men would increase their frequency of HIV testing with home self-testing? AIDS Behav. 2013;17(6):2084–92.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the participants of the Flux Study. This work was funded by the Australian Research Council (ARC; Grant number: DP140102483), and by a Gilead Research Fellowship. The Kirby Institute, the Australian Research Centre in Sex Health and Society, and the Centre for Social Research in Health receive funding from the Australian Government Department of Health.

Benjamin R. Bavinton and Lisa Maher are supported by National Health and Medical Research Council fellowships. For the remaining authors, nothing was declared.

Author information

Authors and Affiliations

  1. Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia

    Benjamin R. Bavinton, Mohamed A. Hammoud, Fengyi Jin, Lisa Maher & Garrett P. Prestage

  2. Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia

    Martin Holt & James MacGibbon

  3. Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand

    Peter Saxton

  4. Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic, Australia

    Adam Bourne

Authors
  1. Benjamin R. Bavinton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed A. Hammoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Holt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Saxton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adam Bourne
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James MacGibbon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fengyi Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lisa Maher
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Garrett P. Prestage
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin R. Bavinton.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bavinton, B.R., Hammoud, M.A., Holt, M. et al. Changes in Sexual Behaviour Following PrEP Initiation Among Australian Gay and Bisexual Men in Relationships: Results from a Prospective Observational Study. AIDS Behav 25, 3704–3711 (2021). https://doi.org/10.1007/s10461-021-03232-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03232-w

Keywords

Search

Navigation