HIV prevention

ARCSHS conducts a program of research that addresses strategic social aspects of HIV prevention. The research program has two broad aims: 1) to provide research evidence that strategically and directly informs HIV prevention activities and policies; and 2) to contribute to the broad body of knowledge around sexual and social practices that are central to HIV prevention. Much of the research activity at ARCSHS that can be found in this report contributes to the evidence base for HIV prevention work, including research with HIV-positive people, research with young people, and research in sexualities. The success of any HIV response depends to a large extent on the comprehensiveness and depth of the evidence base that informs it. This includes research activities that place populations and social practices within the contexts of daily lives, social structures and social histories. The projects highlighted in this section are those with a primary focus on informing specific prevention initiatives. The research program builds on the strengths of the Australian social research response with affected communities and represents a growing sophistication in the focus on contexts, structures and mechanisms of risk and prevention.

Monogamy as an HIV and STI Prevention Strategy for Gay Men

Anthony Smith, Jeffrey Grierson, Garrett Prestage and Duane Duncan

Monogamy, however defined, appears relatively common among Australian gay men and yet is relatively under-researched. At present, little is known about the motivations of Australian gay men to enter into and maintain monogamous relationships. Drawing on data from face-to-face interviews, focus groups, and a nationwide online survey, this study will bring into clear view a phenomenon, and social and intimate practice, that has been almost entirely overlooked and will significantly advance the understanding of the dynamics of gay men’s sexual behaviour and sexual cultures. Regardless of the motivations for monogamy, its practice is by definition an effective means of interrupting the transmission of HIV and STIs, and is worthy of a substantive investigation. The aims of this study are particularly significant given the sustained increase in the reported incidence of new cases of HIV in most states in Australia. It would seem that the old ‘safe sex’ messages have lost their effectiveness and there is a need for innovative responses to the challenges of HIV prevention. The analysis of gay men’s social and sexual behaviour from this study will provide the basis for an effective and focused health promotion campaign.

REACH Partnership (Reinvigorating Evidence for Action and Capacity in Community HIV Programs)

Graham Brown and Kylie Johnston

REACH is a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership. The aim is to facilitate the building of the evidence base for HIV prevention policy and program decisions in Victoria. The outcomes that the REACH Partnership aims to achieve in the first three years are:

  1. increase organisational culture and capacity within the Victorian HIV partnership for sustained evidence building and evaluation;
  2. collaboratively develop monitoring and evaluation approaches for identified HIV prevention programs and projects at the discrete project level as well as the collective policy level;
  3. to contribute to building the evidence base about “what works” that informs policy, programs and agencies;
  4. support and influence decision making at the policy and program level; and
  5. contribute to the evidence base nationally and internationally in HIV prevention.

Overall, the focus of the REACH Partnership is to build a shared evidence base that is recognised in policy and practice as credible, applicable and useable. The role of ARCSHS is to facilitate this process in collaboration with the key organisations in the HIV prevention partnership in Victoria. The detail of the program will be developed in collaboration with the HIV community sector. However the approach and principles guiding the REACH Partnership are:

  1. Evidence building in partnership
  2. Realist evaluation approaches
  3. Participatory action research, capacity building and sustainability
  4. Continuous contribution to the published evidence and literature in HIV prevention
  5. Partnerships for policy, practice and governance

Collaborating organisations include: ALSO Foundation; Country Awareness Network; Family Planning Victoria; Gamma Project; Gay and Lesbian Health Victoria; Multicultural Health and Support Service; People Living with HIV/AIDS Victoria; Positive Women; Straight Arrows; Victorian AIDS Council; Victorian Department of Health; as well as the supporting research programs of ARCSHS, Burnet Institute and Partnership Solutions. The role and participation of each organisation will vary in relation to the resources and capacity of their programs, and appropriate timing of active participation. The project commenced in April 2011 and is funded by the Victorian Department of Health.

ESAPP - Evidence Synthesis and Application for Practice and Policy

Graham Brown, Kylie Johnston and Marian Pitts

This is a collaborative research and practice initiative to review the recent and currently developing evidence base (and evaluation tools) for community based HIV prevention programs. This 12-month project will:

  • draw from community practice, health promotion theory and evaluation research from Australia and internationally to audit the evaluation and evidence building approaches currently being utilised in programs targeted to PLHIV, MSM and priority CALD communities;
  • review recent developments and recommendations in evaluation of HIV prevention and social programs;
  • identify gaps in the published evidence that create barriers to translating the evidence into practice within the community sector;
  • develop recommendations for future work in evaluating HIV prevention and building a useable evidence base for policy and practice in Australia.
The project utilises realist approaches in analysing evidence, ongoing liaison with current national and international evidence building programs, and community and policy consultation. The project is funded by the Commonwealth Department of Health and Ageing and commenced in September 2011. It is expected to continue until December 2012.

Risk, Motivations and HIV among High Risk Gay Men (Pleasure and Sexual Health Study: High Risk Men Who Have Sex with Men and Understandings of Risk)

Garrett Prestage, Michael Hurley, Marian Pitts and Graham Brown

This study measures current attitudes toward HIV and other STIs, and beliefs about relative risk among gay men known to be at highest risk for transmission of these infections, including both HIV-negative and HIV-positive men as well as recent seroconverters, and a subsample of male-to-male sex workers. It explores in detail these beliefs about relative risk, both in terms of their understandings of the relative risk of transmission and the relative priority this understanding of risk takes with respect to other aspects of their lives such as sexual needs, the desire for intimacy and connectedness, a sense of adventure, personal relationships and broader issues of health and wellbeing.

This study recruited gay and bisexual men across the country, with 2306 complete questionnaires for the survey component, including 640 Victorian men and 764 from NSW, as well as 352 Queensland men, 162 South Australian men and 219 men in Western Australia. In addition, fifty in-depth interviews with gay men who are at high risk of HIV infection or transmission were conducted. The qualitative and quantitative arms of the study included HIV-positive and HIV-negative men. Participants were recruited using a variety of methods, both online and through community organisations, social groups and venues. Recruitment focused on, but was not restricted to, men at highest risk of HIV transmission. There was also some targeted recruitment of men engaged in male-to-male sex work and high-risk behaviour, and men who had recently seroconverted. Data collection was completed in September 2009 with the analysis ongoing. A community report was published in 2010.

HIV Seroconversion Study

Garrett Prestage, Ian Down, Graham Brown and Jeanne Ellard (NCHSR)

This study identifies demographic, behavioural, social, situational, and other characteristics in individuals who have been recently diagnosed with HIV infection. An understanding of those factors associated with HIV infection will lead to improved preventive education both at a level of individual counselling and community-wide strategies. The study aims to recruit at least 100 recently diagnosed individuals across Australia each year, who will complete a self-administered online questionnaire. In addition, about 20 in-depth interviews with individuals who have recently been diagnosed with HIV will be conducted. Participants will be recruited through community organisation programs servicing those who have recently seroconverted, and through clinic sites with a high caseload of recent HIV diagnoses, as well as through more broad-based publicity. At the end of December 2012, 424 individuals who had recently seroconverted had participated in the survey and 72 had been interviewed. Two community reports have already been produced. Data collection and analysis is ongoing.

NSW HIV Modelling and Acceptability Study

Garrett Prestage, Ian Down, Richard Gray (Kirby Institute) and David Wilson (Kirby Institute)

This study assesses the potential impact of a range of interventions on the projected HIV epidemic among gay men in NSW and the feasibility of such interventions based on their acceptability among gay men. The project recruited over 300 men in NSW and a further 300 men from across Australia. In addition, five focus groups were conducted in Sydney. The qualitative and quantitative arms of the study included both HIV-positive and HIV-negative men. Participants were recruited using a variety of methods, both online and through community organisations, social groups and venues. Recruitment was focused on, but not restricted to, men at highest risk of HIV transmission. Data collection was completed in May 2010. Data analysis is ongoing and a community report has been published.

Sexually Adventurous Men Project – Documenting and Process Evaluation

Graham Brown, Kylie Johnson and Garrett Prestage

The Sexually Adventurous Men (SAM) Project is a joint partnership between the Victorian AIDS Council/Gay Men’s Health Centre (VAC/GMHC), People Living with HIV/AIDS Victoria (PLWHA), and ARCSHS.

ARCSHS has monitored and supported the project as it was developed and evolved since 2009. This study documents and analyses the SAM Project's process of community engagement and community development, resource development, and online initiatives within sexually adventurous networks. From its inception, the SAM project has worked to establish and maintain strategic alliances with party organisers, venue owners and social groups, as well as more generally with sexually adventurous men. Throughout the project’s development and implementation, the project staff have worked to facilitate opportunities for suggestions, feedback and direct involvement in the development of the sexual health initiatives by the project.

The documenting and analysis role by ARCSHS includes strategies such as project worker diaries, reports, and interviews as well as in-depth interviews with community stakeholders and partners. It documents the learning and experiences of this evolving initiative, supports the project's strategic planning, and contributes to a co-written evaluation report and recommendations with an external consultant (Aldo Spinner). The next phase will include developing approaches to survey members of the sexually adventurous men community in collaboration with community groups and online initiatives. Funding for this project comes from VAC/GMHC and PLWHA Vic.

9 May 2012