ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

Posted by on in Social and behavioural research
Friday final words

RELATIONSHIPS AND COMMUNICATION

These words were repeated today in all sessions I attended.

What is a relationship for gay men?

How successfully do gay men communicate with each other? And why is this important for HIV and STI prevention?

The session today titled Gay Men, Sex and HIV Prevention thoroughly explored the various combinations spoken of relationships that gay men talk about in the Monopoly study. Different aspects such as Agreement whether formalised or implied, which cohort of gay men are more likely to make these agreements and why or how are they broken or bended?

What did I learn today?

WORDS words Words!!

In USA they use " steady" instead of "regular" and the chasm between regular and casual is very wide in relation to what the researchers say gay men are negotiating.In Australia the fallaback option is monogamy,  so if it is not then what is it? According to one researcher about three quarters of men in the study said they had a regular partner , but only 40% of the men also stated that they were in a relationship;  so men are often in a relationship with a fuckbudy, where does this behaviour get discussed in relation to HIV transmission risk? Typical consultations may miss these types of relationships if prior knowledge of regular partners is known.

Relationships according to how old a gay man is was then explored, with the aversge age of gay men in the Monopoly study being mid thirties , the question was posed do young gay men behave or think they behave the same way?

Generally the evidence was that young gay men had fewer explicit agreements, it was surmisec that they assume monogomy until it wasn't! Young gay men were less likely to discuss HIV risk reduction and relationships were of shorter duration. However somewhat surprising engaging in condomless sex was relative similar despite the age.

The use of the term now condomless instead of unprotected sex was discussed, this term accurately describes the act of sex, however, any person may have taken other steps into reduce the risk of HIV and STIs by choosing who to have sex with, know the Viral load status of themselves and sexual partner or even take PrEP.

This was discussed by Martin Holt who presented results that HIV positive men, HIV negative men both took other measures to reduce the risk of HIV transmission, with knowing their undetectable  viral load as the most commonly practiced method. A question from the floor added about what do we know about those who are unknown or not tested; it was thought that these men assumed they were negative.

Then onto the lively session on PrEP

In a  nutshell: IT WORKS, IT IS REASONABLY SAFE, GAY MEN WANT TO USE IT, SOME GREAT GPS ARE CREATIVE IN SUPORTING CLIENT CHOICE AND ACCESS AND DEMAND IS GROWING. WHAT WE NEED IS ACCESS SOONER THAN LATER AND RESEARCH INTO THE LONG TERM EFFECTS.

Tagged in: HIVAIDS2015

Posted by on in Social and behavioural research
I attended the launch of HIV Futures 8
This is a survey about health, treatments, work, finances, sex and relationships of people living with HIV (PLHIV). 
 
The survey seeks to gather information from all people living with HIV, including gay and bisexual men, women, heterosexual men and transgender people. The survey will be open until 14th March 2016.
http://www.hivfutures.org.au
 
Please recommend this survey to all people you know living with HIV.
Tagged in: HIVAIDS2015

Posted by on in Social and behavioural research

I attended an excellent talks this morning by Steven Philpot on the fine line in changing agreements between gay men when it was about monogamy.Steven utilised   the Monopoly results that gay men will negotiate changes in relationships,there was also a lot of internal conflict about this subject with a lot of couples,most men usually change their relationship from monogamous to an open relationship.

At the conclusion of the talk Steven reiterated that communication was vital in all relationships.

Benjamin Bavinton also provided an excellent talk during the session on the Definition of Partners.

Partners are either described as either regular or casual,but I would like to know when a f!ckbuddy becomes a relationship.

Approximately 60% of gay men have a regular partner,half of these were monogamous while the other half have a regular partner and casual partners.Most gay men in the Monopoly study were found to be in an open relationship. Condoms were much less likely to be used in an relationship,than they were with f!ck  buddies.The majority of me met there partners online.Transmisions were more likely to come from f!ck buddies.

Garret Prestage provided a good talk on age and relationships and it was heartening to hear that us oldies are much less risk takers than our younger counterparts.Garrett once again reiterated that most regular partners didn't use condoms.That being said it means the risk of transmission  is greater if we trust each other in a relationship.

Martin Holts talk was perhaps the most engaging as he spoke about the use of Viral Load undetectable as a means for condom less sex,he also identified serous orating as another means for condomless sex. Martin identified that at least 75% of men are practising at least one strategy to avoid HIV.Serosorting is now common as a means for condo less sex.

1 in 5 gay men now have condo less sex

41% of these are HIV positive 

21% are HIV negative

19 % are untested.

The most common strategies employed by groups for condo less sex are if positive utilising an undetctable status and Serosorting ,if negative utilising Serosorting and condoms

Benjamin reiterated at the end of the lecture that with guys who have an undetectable viral load the risk of transmission is low.

A very thought provoking session

Tagged in: HIVAIDS2015

This morning we saw a series of presentations from the Monopoly Study, which is a national Australian study that looked at how gay and bisexual men think about and conduct their relationships. They looked at whether gay men have explicit relationship agreements with their regular partners, particularly around issues like monogamy. They also presented finding around why and when couples change their relationship agreements from monogamous to open and vice versa.

Some interesting points included:

  • There is inconsistent classification of sexual partners in the literature. Generally in Australia partners are classified as either "regular" or "casual", but the definition of these categories is inconsistent. Particularly, they highlighted that "fuckbuddies" can be placed in either the regular or casual partner category, and perhaps clinicians and data collectors need to consider this group of partners as separate to either regular or casual partners.
  • Young men have shorter relationships than their older counterparts.
  • Young men tend to assume that being in a relationship means that the relationship is monogamous, so they don't tend to have explicit relationship agreements. There was some discussion on why this may be so. One thought was that these days young gay men tend to have more heterosexual friends than in previous generations, and hence they tend to have views on relationships that mirror their heterosexual counterparts. I think that perhaps this may also underlie the change in relationships amongst young heterosexuals, where it seems that young heterosexual couples now more often make explicit agreements around monogamy vs having an open relationship. Another possible contributor to the lack of relationship agreements among young gay couples is the ongoing marriage equality campaign. I think it's fair to say that the marriage equality campaign in Australia tends to promote monogamous gay relationships as being "the norm", and tend to ignore the many other possible types of gay relationships. Such campaigns may have altered the perception of young gay men on what is expected in a gay relationship, and hence they don't feel the need to have an explicit agreement.
  • Older men tend to have explicit relationship agreements. The explanation offered was that many gay men over time come to the realisation that relationships are complex, and that the supposed "rules" dictated by social norms are not concrete. As such, they feel that it's important to discuss the needs of both partners, and that an agreement is reached, which is may subsequently be revised when the couple's needs change.

So what does all of this mean for clinicians?

  1. It may be useful to ask patients about fuckbuddies when talking about their relationships, and to ask what agreements people have with their fuckbuddies. In the "casual" vs "regular" linguistic dichotomy, fuckbuddies may get lumped in the "casual" category, and thus not get the attention they deserve.
  2. We must ask young gay guys whether they have explicit relationship agreements with their regular partners and fuckbuddies, as this data shows that they often assume that their relationships are monogamous. The assumption of monogamy may place them at increased risk of HIV and STIs.

Posted by on in Social and behavioural research

A summary of today (Thursday 17 September 2015)

Jeffery Klausner - new technologies and innovations to facilitate HIV prevention, testing and care

The future of health care is with mobile technology.

Primary prevention - exposure reduction

Directed us to look at a YouTube video (Willie and Twinkle) as being a good example of sexual health education for young people.

Healthvana - An app that acquires data from laboratory or clinician as evidence of health status. The app keeps the info for 3 months and men can use the information for sero sorting.

Gamesmanship is a way to engage people in health - gave example of a quit smoking game. Below are some other examples

 Play itsafe - on line game, with an avatar

Epic allies - game to improve medication adherence for young HIV pos black MSM.  Good for hard to reach populations, who don't have strong social support.

I got your back 

Secondary prevention

Testing

HIV and testing locators - to find and make appointments on line

Self testing - modest uptake in USA. Placed vending machine in car park of West Hollywood gay and lesbian centre. Is an option for people who don't want to engage with clinician. 

Vouchers - developed voucher system in partnership with pharmacy chain. 

Banner ad on Grindr - people don't take notice of banner ads so bought Blast ads which people have to click thru - and then can select which method they wish to receive self test.

Adherence

Weekly SMS messages improved viral load outcomes - the use of SMS messages emphasised the importance of caring for the patient

Oregon reminders - can set up own messages

Vancouver research - sent weekly SMS reminders to people with Viral load >200 - this intervention improved VL rates over time

At the AFAO Community Hub at lunchtime the panel of Max, Dean and Harry provided Victorian perspectives on their community conversations, strengthening PrEP in the next NSW HIV Strategy,  and Max on personal and professional perspectives of PrEP and the importance of men having a range of different prevention strategies. 

Issues discussed by the panel were accessibility, cost and standards of imported drugs.

Challenges - Max reported many conversations helping people find the words to start the conversation with their doctor- many have a fear of being judged by their doctor.

Key messages from today are the importance of community involvement in prevention programs, and the usefulness of new technologies to work with at risk groups of people.

Tagged in: HIVAIDS2015

Please join us for a memorial event celebrating the life of one of Australia’s leading HIV advocates, Levinia Crook… https://t.co/N7dof5xaGa

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