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Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019–2021

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Title: Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019–2021
Authors: Simin Yu, Benjamin R. Bavinton, Curtis Chan, James MacGibbon, Limin Mao, Daniel Vujcich, Timothy R. Broady, Martin Holt
Source: Journal of the International AIDS Society, Vol 27, Iss 1, Pp n/a-n/a (2024)
Publisher Information: Wiley, 2024.
Publication Year: 2024
Collection: LCC:Immunologic diseases. Allergy
Subject Terms: gay and bisexual men, HIV prevention, HIV testing, men who have sex with men, migrant, pre‐exposure prophylaxis, Immunologic diseases. Allergy, RC581-607
More Details: Abstract Introduction: Overseas‐born gay and bisexual men (GBM) are overrepresented in HIV diagnoses in Australia. We assessed social and sexual behaviours, and the use of HIV prevention and testing, by region of birth and length of residence in Australia. We sought to identify similarities and differences between recently arrived and non‐recently arrived GBM from non‐English‐speaking countries to improve targeting and engagement with HIV testing and prevention. Methods: Data were collected in national repeated, behavioural surveillance surveys conducted across Australia during 2019–2021. Logistic regression was used to identify factors that differentiated between recently arrived (
Document Type: article
File Description: electronic resource
Language: English
ISSN: 1758-2652
Relation: https://doaj.org/toc/1758-2652
DOI: 10.1002/jia2.26204
Access URL: https://doaj.org/article/de72563d3c614cfb8682a8d691c412ab
Accession Number: edsdoj.72563d3c614cfb8682a8d691c412ab
Database: Directory of Open Access Journals
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  Value: <anid>AN0175070918;[96hg]01jan.24;2024Jan31.04:50;v2.2.500</anid> <title id="AN0175070918-1">Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019–2021 </title> <p>Introduction: Overseas‐born gay and bisexual men (GBM) are overrepresented in HIV diagnoses in Australia. We assessed social and sexual behaviours, and the use of HIV prevention and testing, by region of birth and length of residence in Australia. We sought to identify similarities and differences between recently arrived and non‐recently arrived GBM from non‐English‐speaking countries to improve targeting and engagement with HIV testing and prevention. Methods: Data were collected in national repeated, behavioural surveillance surveys conducted across Australia during 2019–2021. Logistic regression was used to identify factors that differentiated between recently arrived (<2 years) and non‐recently arrived (≥2 years in Australia) GBM from non‐English‐speaking countries. Results: Among 24,707 participants in 2019–21, 2811 (11.4%) were from high‐income English‐speaking countries, 714 (2.9%) were recently arrived overseas‐born GBM and 3833 (15.5%) were non‐recently arrived migrants. Recently arrived GBM were most likely to be born in Asia (36.1%) and Europe (21.1%). Compared with non‐recently arrived GBM, recently arrived GBM from non‐English‐speaking countries were younger (aOR = 0.95, 95% CI = 0.94–0.96, p<0.001), more likely to be students (aOR = 1.43, 95% CI = 1.11–1.85, p = 0.005), less likely to be in full‐time employment (aOR = 0.56, 95% CI = 0.46–0.69, p <0.001), more likely to report consistent condom use (aOR = 1.30, 95% CI = 1.01–1.66, p = 0.039), but had lower awareness (aOR = 0.62, 95% CI = 0.48–0.80, p<0.001) and use of pre‐exposure prophylaxis (PrEP) (22.8%, vs. 32.3%, χ2(<reflink idref="bib1" id="ref1">1</reflink>, 4185) = 23.78, p<0.001), and similar levels of casual sex with a risk of HIV acquisition or transmission (aOR = 1.29, 95% CI = 0.98–1.69, p = 0.066). Recently arrived GBM reported similar levels of lifetime HIV testing (aOR = 0.97, 95% CI = 0.54–1.74, p = 0.915) and recent HIV testing (OR = 1.03, 95% CI = 0.86–1.22, p = 0.779), but were much less likely to have tested at general practitioners (aOR = 0.53, 95% CI = 0.41–0.68, p<0.001) and more likely to report testing at hospitals (aOR = 3.35, 95% CI = 2.53–4.43, p<0.001), at home (aOR = 2.85, 95% CI = 1.63–4.99, p<0.001), or community‐based services (aOR = 1.36, 95% CI = 1.01–1.84, p = 0.043). Conclusions: Recently arrived GBM from non‐English‐speaking countries reported similar levels of risk of HIV acquisition to longer‐term residents in Australia, but lower levels of PrEP awareness and use, and more reliance on HIV testing services which are free or low cost. It is necessary to enhance access to HIV testing and prevention among recently arrived GBM in Australia.</p> <p>Keywords: gay and bisexual men; HIV prevention; HIV testing; men who have sex with men; migrant; pre‐exposure prophylaxis</p> <hd id="AN0175070918-2">INTRODUCTION</hd> <p>In 2020, 29.8% of Australia's population was born overseas and over 7.6 million migrants were living in Australia [[<reflink idref="bib1" id="ref2">1</reflink>]]. In 2019, there were 2.43 million temporary migrants in Australia [[<reflink idref="bib2" id="ref3">2</reflink>]], many of whom were international students [[<reflink idref="bib3" id="ref4">3</reflink>]].</p> <p>Migrants are a priority for HIV prevention in Australia, which has an HIV epidemic concentrated among gay and bisexual men (GBM) [[<reflink idref="bib4" id="ref5">4</reflink>]]. During 2012–19, annual HIV diagnoses decreased by 43% among Australian‐born GBM, but diagnoses rose 54% among overseas‐born men, particularly from Asia [[<reflink idref="bib5" id="ref6">5</reflink>], [<reflink idref="bib7" id="ref7">7</reflink>]].</p> <p>Length of residence in Australia may affect migrants' sexual behaviour and use of HIV prevention [[<reflink idref="bib6" id="ref8">6</reflink>], [<reflink idref="bib8" id="ref9">8</reflink>]]. Recently arrived GBM who have been diagnosed with HIV report less access to and use of prevention methods prior to their diagnosis, particularly pre‐exposure prophylaxis (PrEP) [[<reflink idref="bib6" id="ref10">6</reflink>]]. Known barriers included language fluency [[<reflink idref="bib8" id="ref11">8</reflink>]], lower incomes [[<reflink idref="bib10" id="ref12">10</reflink>]], cultural and religious factors [[<reflink idref="bib11" id="ref13">11</reflink>]], a perception that HIV is not a public health concern in Australia [[<reflink idref="bib9" id="ref14">9</reflink>]], fear of stigma or discrimination [[<reflink idref="bib13" id="ref15">13</reflink>], [<reflink idref="bib15" id="ref16">15</reflink>], [<reflink idref="bib17" id="ref17">17</reflink>]] and poorer knowledge of effective HIV prevention strategies [[<reflink idref="bib6" id="ref18">6</reflink>], [<reflink idref="bib11" id="ref19">11</reflink>]]. Medicare, Australia's national health insurance scheme, is not available to most temporary residents, who may need to pay for private health insurance and to attend health services [[<reflink idref="bib18" id="ref20">18</reflink>]]. These issues are particularly acute among newer, recently arrived migrants from non‐English‐speaking countries [[<reflink idref="bib8" id="ref21">8</reflink>], [<reflink idref="bib15" id="ref22">15</reflink>]].</p> <p>Previous research has been conducted with overseas‐born GBM in Australia, utilizing small clinic‐based samples [[<reflink idref="bib6" id="ref23">6</reflink>], [<reflink idref="bib8" id="ref24">8</reflink>], [<reflink idref="bib15" id="ref25">15</reflink>], [<reflink idref="bib19" id="ref26">19</reflink>]]. These studies showed that many recent arrivals were international students who spoke a language other than English at home [[<reflink idref="bib6" id="ref27">6</reflink>], [<reflink idref="bib8" id="ref28">8</reflink>], [<reflink idref="bib15" id="ref29">15</reflink>]], did not have Medicare coverage [[<reflink idref="bib6" id="ref30">6</reflink>], [<reflink idref="bib8" id="ref31">8</reflink>]], and had poorer knowledge about and were less likely to access HIV testing than Australian‐born GBM [[<reflink idref="bib6" id="ref32">6</reflink>], [<reflink idref="bib8" id="ref33">8</reflink>], [<reflink idref="bib15" id="ref34">15</reflink>]]. The current analysis used a national, community‐based sample of GBM, to compare the characteristics of recently and non‐recently arrived overseas‐born GBM, in order to improve the targeting of HIV prevention and testing.</p> <hd id="AN0175070918-3">METHODS</hd> <p></p> <hd id="AN0175070918-4">Participants and recruitment</hd> <p>Data were collected from the Gay Community Periodic Surveys [[<reflink idref="bib20" id="ref35">20</reflink>]], repeated cross‐sectional surveys that recruit GBM from gay community events, venues, and online in seven states and territories. Time‐location sampling is used for venue and event‐based recruitment. Paper questionnaires (in English) are distributed and collected by trained staff. Online recruitment is driven by paid Facebook advertising. The online questionnaire is available in English, simplified and traditional Chinese, Indonesian, Portuguese, Spanish, Thai and Vietnamese.</p> <p>Participants were eligible if they were ≥16 years old (online recruitment) or ≥18 years old (in‐person recruitment), identified as male (cisgender or transgender), as gay or bisexual, or had sex with another man in the past 5 years and lived in Australia. Ethical approval was received from the University of New South Wales (HC 180903) and two community organizations (ACON and Thorne Harbour Health). For in‐person recruitment, participants are provided study information by a recruiter, and are provided with a questionnaire to self‐complete, after giving verbal consent. For online recruitment, participants read the study information online, and access the online questionnaire after giving electronic consent.</p> <hd id="AN0175070918-5">Measures</hd> <p>Migration/residency status was identified using participants' country of birth and length of time living in Australia. Countries of birth were categorized into eight groups: Africa, Australia, other high‐income English‐speaking countries, Asia, Europe, Central and South America, Oceania and the Middle East. Migrants living in Australia for less than 2 years were considered recently arrived, and for 2 or more years non‐recently arrived.</p> <p>Demographic variables included age, sexual identity, student status, education, employment and state of residence. Gay social engagement (GSE) was measured with two questions: how many of your friends are gay men (scored 0–4) and how much of your free time is spent with gay men (scored 0–3). These scores were summed with participants who scored ≤3 categorized as having low GSE and participants scoring 4–7 high GSE [[<reflink idref="bib22" id="ref36">22</reflink>]]. Sexual behaviour included the number of recent male sex partners and any group sex (in the past 6 months). Sexual behaviour with casual male partners in the previous 6 months was categorized into five groups: no casual partners; casual partners but no anal intercourse; using condoms consistently for anal intercourse; having condomless sex but being HIV negative and on PrEP, or HIV positive, on treatment and having an undetectable viral load (UVL); having condomless sex and being HIV negative or untested and not on PrEP, or being HIV positive, not on treatment or having a detectable viral load (DVL). Participants in groups 1–4 were classified as reporting casual sex without a risk of HIV acquisition or transmission and group 5 as reporting casual sex with a risk of HIV acquisition or transmission [[<reflink idref="bib23" id="ref37">23</reflink>]]. Self‐reported HIV status, recent drug use, sexually transmitted infection (STI) testing, HIV testing frequency and locations for testing were also included.</p> <hd id="AN0175070918-6">Analysis</hd> <p>Bivariate and multivariate logistic regression models were used to compare recently arrived and non‐recently arrived overseas‐born GBM, excluding those from high‐income English‐speaking countries. Variables for which there was a statistical difference at a bivariate level of <emph>p</emph><0.10 were included in a multivariable logistic regression model to identify statistically independent differences (<emph>p</emph><0.05). Analysis was conducted using Stata version 16.0 (StataCorp, College Station, TX).</p> <hd id="AN0175070918-7">RESULTS</hd> <p>In total, 24,815 questionnaires were completed between 2019 and 2021, 24,620 in English, 195 in other languages, 12,932 (52.1%) in person and 11,883 (47.9%) online. One hundred and eight participants were excluded who did not provide a country of birth. Of the 24,707 remaining, 70.1% were born in Australia, 11.4% in high‐income English‐speaking countries and 18.6% from other countries. Participants born in Australia and high‐income English‐speaking countries were excluded.</p> <p>Among 4585 GBM born in non‐English‐speaking countries, 38 did not indicate the length of residence in Australia and were also excluded. Of the final 4547 participants, 15.7% had been living in Australia for less than 2 years (recently arrived) and 84.3% had been living in Australia for 2 years or more (non‐recently arrived) (Table 1). The most common region of birth was Asia. The top five countries of birth among recently arrived GBM were Brazil, Colombia, the Philippines, China and Malaysia, while among non‐recently arrived GBM, they were Malaysia, the Philippines, South Africa, China and India.</p> <p>1 Table Participant characteristics and multivariate logistic regression comparing recently arrived and non‐recently arrived GBM (<emph>N</emph> = 4547)</p> <p> <ephtml> <table><thead><tr><th align="left" /><th align="center"><p>Total</p><p><italic>N</italic> = 4547</p></th><th align="center"><p>Non‐recently arrived</p><p><italic>n</italic> = 3833</p></th><th align="center"><p>Recently arrived</p><p><italic>n</italic> = 714</p></th><th align="center">OR (95% CI)</th><th align="center"><italic>p</italic></th><th align="center">AOR (95% CI)</th><th align="center"><italic>p</italic></th></tr></thead><tbody><tr><td>Region of birth</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Asia</td><td>1936 (42.6)</td><td>1678 (43.8)</td><td>258 (36.1)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Europe</td><td>734 (16.1)</td><td>583 (15.2)</td><td>151 (21.1)</td><td>1.68 (1.35−2.10)</td><td><0.0010002</td><td>2.67 (2.09−3.42)</td><td><0.0010002</td></tr><tr><td>Central or South America</td><td>583 (12.8)</td><td>434 (11.3)</td><td>149 (20.9)</td><td>2.23 (1.78−2.80)</td><td><0.0010002</td><td>2.22 (1.73−2.85)</td><td><0.0010002</td></tr><tr><td>Africa</td><td>356 (7.8)</td><td>332 (8.7)</td><td>24 (3.4)</td><td>0.47 (0.30−0.73)</td><td>0.0010002</td><td>0.81 (0.50−1.32)</td><td>0.396</td></tr><tr><td>Oceania</td><td>85 (1.9)</td><td>80 (2.1)</td><td>5 (0.7)</td><td>0.41 (0.16−1.01)</td><td>0.053</td><td>0.59 (0.24−1.44)</td><td>0.248</td></tr><tr><td>Middle East</td><td>189 (4.2)</td><td>163 (4.3)</td><td>26 (3.6)</td><td>1.04 (0.67−1.60)</td><td>0.868</td><td>1.28 (0.79−2.06)</td><td>0.315</td></tr><tr><td>Overseas—unspecified</td><td>664 (14.6)</td><td>563 (14.7)</td><td>101 (14.1)</td><td>1.17 (0.91−1.50)</td><td>0.225</td><td>1.62 (1.23−2.13)</td><td>0.0010002</td></tr><tr><td>Age (M/IQR)</td><td>33 (28−41)</td><td>35 (29−42)</td><td>29.0 (25−33)</td><td>0.93 (0.92−0.95)</td><td><0.0010002</td><td>0.95 (0.94−0.96)</td><td><0.0010002</td></tr><tr><td>Sexual identity</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Gay</td><td>3883 (85.4)</td><td>3290 (85.8)</td><td>593 (83.1)</td><td>Ref.</td><td /><td /><td /></tr><tr><td>Bisexual</td><td>458 (10.1)</td><td>373 (9.7)</td><td>85 (11.9)</td><td>1.26 (0.98−1.63)</td><td>0.067</td><td /><td /></tr><tr><td>Others</td><td>206 (4.5)</td><td>170 (4.4)</td><td>36 (5.0)</td><td>1.17 (0.81−1.70)</td><td>0.393</td><td /><td /></tr><tr><td>Student</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>3832 (84.3)</td><td>3346 (87.3)</td><td>486 (68.1)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Yes</td><td>715 (15.7)</td><td>487 (12.7)</td><td>228 (31.9)</td><td>3.22 (2.68−3.87)</td><td><0.0010002</td><td>1.43 (1.11−1.85)</td><td>0.0050002</td></tr><tr><td>Education</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No university education</td><td>1187 (26.1)</td><td>1015 (26.5)</td><td>172 (24.1)</td><td>Ref.</td><td /><td /><td /></tr><tr><td>University educated</td><td>3360 (73.9)</td><td>2818 (73.5)</td><td>542 (75.9)</td><td>1.14 (0.94−1.37)</td><td /><td /><td /></tr><tr><td>Full‐time employment</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>1791 (39.4)</td><td>1371 (35.8)</td><td>420 (58.8)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Yes</td><td>2756 (60.6)</td><td>2462 (64.2)</td><td>294 (41.2)</td><td>0.39 (0.33−0.46)</td><td><0.0010002</td><td>0.56 (0.46−0.69)</td><td><0.0010002</td></tr><tr><td>State</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>New South Wales</td><td>2110 (46.4)</td><td>1751 (45.7)</td><td>359 (50.3)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Victoria</td><td>1395 (30.7)</td><td>1166 (30.4)</td><td>229 (32.1)</td><td>0.96 (0.80−1.15)</td><td>0.643</td><td>1.02 (0.84−1.25)</td><td>0.823</td></tr><tr><td>Queensland</td><td>506 (11.1)</td><td>435 (11.3)</td><td>71 (9.9)</td><td>0.80 (0.60−1.05)</td><td>0.105</td><td>0.78 (0.58−1.05)</td><td>0.102</td></tr><tr><td>Others</td><td>536 (11.8)</td><td>481 (12.5)</td><td>55 (7.7)</td><td>0.56 (0.41−0.75)</td><td><0.0010002</td><td>0.53 (0.38−0.74)</td><td><0.0010002</td></tr><tr><td>Gay social engagement</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Low</td><td>1646 (36.2)</td><td>1355 (35.4)</td><td>291 (40.8)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>High</td><td>2901 (63.8)</td><td>2478 (64.6)</td><td>423 (59.2)</td><td>0.79 (0.68−0.94)</td><td>0.0060002</td><td>0.95 (0.79−1.14)</td><td>0.559</td></tr><tr><td>Ever been tested for HIV</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>415 (9.1)</td><td>326 (8.5)</td><td>89 (12.5)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Yes</td><td>4132 (90.9)</td><td>3507 (91.5)</td><td>625 (87.5)</td><td>0.65 (0.51−0.84)</td><td>0.0010002</td><td>0.97 (0.54−1.74)</td><td>0.915</td></tr><tr><td>HIV testing (last 12 months)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>1415 (31.1)</td><td>1196 (31.2)</td><td>219 (30.7)</td><td>Ref.</td><td /><td /><td /></tr><tr><td>Yes</td><td>3132 (68.9)</td><td>2637 (68.8)</td><td>495 (69.3)</td><td>1.03 (0.86−1.22)</td><td>0.779</td><td /><td /></tr><tr><td>Last HIV test at a GP</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>3178 (69.9)</td><td>2555 (66.7)</td><td>623 (87.3)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Yes</td><td>1369 (30.1)</td><td>1278 (33.3)</td><td>91 (12.7)</td><td>0.29 (0.23−0.37)</td><td><0.0010002</td><td>0.53 (0.41−0.68)</td><td><0.0010002</td></tr><tr><td>Last HIV test at a sexual health clinic</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>2750 (60.5)</td><td>2307 (60.2)</td><td>443 (62.0)</td><td>Ref.</td><td /><td /><td /></tr><tr><td>Yes</td><td>1797 (39.5)</td><td>1526 (39.8)</td><td>271 (38.0)</td><td>0.92 (0.78−1.09)</td><td>0.352</td><td /><td /></tr><tr><td>Last HIV test at a hospital</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>4211 (92.6)</td><td>3622 (94.5)</td><td>589 (82.5)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Yes</td><td>336 (7.4)</td><td>211 (5.5)</td><td>125 (17.5)</td><td>3.64 (2.87−4.62)</td><td><0.0010002</td><td>3.35 (2.53−4.43)</td><td><0.0010002</td></tr><tr><td>Last HIV test at home</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>4488 (98.7)</td><td>3797 (99.1)</td><td>691 (96.8)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Yes</td><td>59 (1.3)</td><td>36 (0.9)</td><td>23 (3.2)</td><td>3.51 (2.07−5396)</td><td><0.0010002</td><td>2.85 (1.63−4.99)</td><td><0.0010002</td></tr><tr><td>Last HIV test at community‐based service</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>4160 (91.5)</td><td>3522 (91.9)</td><td>638 (89.4)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Yes</td><td>387 (8.5)</td><td>311 (8.1)</td><td>76 (10.6)</td><td>1.35 (1.03−1.76)</td><td>0.0270002</td><td>1.36 (1.01−1.84)</td><td>0.0430002</td></tr><tr><td>HIV status</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>HIV negative</td><td>3743 (82.3)</td><td>3167 (82.6)</td><td>576 (80.7)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>HIV positive</td><td>362 (8.0)</td><td>314 (8.2)</td><td>48 (6.7)</td><td>0.84 (0.61−1.15)</td><td>0.282</td><td>1.24 (0.88−1.75)</td><td>0.222</td></tr><tr><td>Unknown/untested</td><td>442 (9.7)</td><td>352 (9.2)</td><td>90 (12.6)</td><td>1.41 (1.10−1.80)</td><td>0.0070002</td><td>0.94 (0.54−1.65)</td><td>0.831</td></tr><tr><td>Any STI diagnosis (last 12 months)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>3369 (74.1)</td><td>2833 (73.9)</td><td>536 (75.1)</td><td>Ref.</td><td /><td /><td /></tr><tr><td>Yes</td><td>1178 (25.9)</td><td>1000 (26.1)</td><td>178 (24.9)</td><td>0.94 (0.78−1.13)</td><td>0.516</td><td /><td /></tr><tr><td>PrEP awareness</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Not heard of PrEP</td><td>570 (12.5)</td><td>427 (11.1)</td><td>143 (20.0)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Knew PrEP was available</td><td>3977 (87.5)</td><td>3406 (88.9)</td><td>571 (80.0)</td><td>0.50 (0.41−0.62)</td><td><0.0010002</td><td>0.62 (0.48−0.80)</td><td><0.0010002</td></tr><tr><td>Number of male sex partners (last 6 months)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>0–10</td><td>3580 (78.7)</td><td>3016 (78.7)</td><td>564 (79.0)</td><td>Ref.</td><td /><td /><td /></tr><tr><td>>10</td><td>967 (21.3)</td><td>817 (21.3)</td><td>150 (21.0)</td><td>0.98 (0.81−1.19)</td><td>0.854</td><td /><td /></tr><tr><td>Sexual behaviour with casual male partners (last 6 months)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No casual partners</td><td>1756 (38.6)</td><td>1477 (38.5)</td><td>279 (39.1)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Casual partners but no anal intercourse</td><td>427 (9.4)</td><td>370 (9.7)</td><td>57 (8.0)</td><td>0.82 (0.60−1.11)</td><td>0.193</td><td>0.92 (0.67−1.28)</td><td>0.620</td></tr><tr><td>Casual partners and consistent condom use</td><td>732 (16.1)</td><td>587 (15.3)</td><td>145 (20.3)</td><td>1.31 (1.05−1.63)</td><td>0.0180002</td><td>1.30 (1.01−1.66)</td><td>0.0390002</td></tr><tr><td>Condomless sex with casual partners, but on PrEP or undetectable viral load</td><td>1027 (22.6)</td><td>914 (23.8)</td><td>113 (15.8)</td><td>0.65 (0.52−0.83)</td><td><0.0010002</td><td>0.87 (0.66−1.14)</td><td>0.318</td></tr><tr><td>Condomless sex with casual partners, but not on PrEP, or not on treatment or detectable viral load</td><td>605 (13.3)</td><td>485 (12.7)</td><td>120 (16.8)</td><td>1.31 (1.03−1.66)</td><td>0.0260002</td><td>1.29 (0.98−1.69)</td><td>0.066</td></tr><tr><td>Group sex (last 6 months)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>3097 (68.1)</td><td>2594 (67.7)</td><td>503 (70.4)</td><td>Ref.</td><td /><td /><td /></tr><tr><td>Yes</td><td>1450 (31.9)</td><td>1239 (32.3)</td><td>211 (29.6)</td><td>0.88 (0.74−1.05)</td><td>0.145</td><td /><td /></tr><tr><td>Used drugs for sex (last 6 months)</td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>No</td><td>3863 (85.0)</td><td>3238 (84.5)</td><td>625 (87.5)</td><td>Ref.</td><td /><td>Ref.</td><td /></tr><tr><td>Yes</td><td>684 (15.0)</td><td>595 (15.5)</td><td>89 (12.5)</td><td>0.77 (0.61−0.98)</td><td>0.0360002</td><td>0.85 (0.65−1.11)</td><td>0.235</td></tr></tbody></table> </ephtml> </p> <p>1 Abbreviations: CI, confidence interval; GP, general practitioner; M/IQR, median/interquartile rage; PrEP, pre‐exposure prophylaxis; Ref., reference; STI, sexually transmitted infection.</p> <p>2 * <emph>p</emph><0.05.</p> <p>In the bivariate results, recently arrived GBM were less likely to have ever tested for HIV compared with non‐recently arrived GBM, but similar proportions had tested within the past year (Table 1). Recently arrived GBM were less likely to have recently tested at a general practitioner (GP), and more likely to have tested at a hospital, at home or a community‐based service. Recently arrived GBM were more likely to report an unknown or untested HIV status. Levels of STI diagnoses in the last 12 months were similar. Recently arrived GBM had lower PrEP awareness than non‐recently arrived GBM. Restricting the sample to non‐HIV‐positive overseas‐born GBM (<emph>n</emph> = 4185), recently arrived GBM were less likely than non‐recently arrived GBM to have used PrEP in the last 6 months (22.8% vs. 32.3%, χ<sups>2</sups>(<reflink idref="bib1" id="ref38">1</reflink>, 4185) = 23.78, <emph>p</emph><0.001). Further restricting the sample to overseas‐born GBM who had used PrEP (<emph>n</emph> = 1290), recently arrived GBM were less likely than non‐recently arrived GBM to get PrEP from a pharmacy (30.9% vs. 66.0%, χ<sups>2</sups>(<reflink idref="bib1" id="ref39">1</reflink>, 1290) = 70.31, <emph>p</emph><0.001), and more likely to buy it online from overseas (44.7% vs. 16.6%, χ<sups>2</sups>(<reflink idref="bib1" id="ref40">1</reflink>, 1290) = 66.50, <emph>p</emph><0.001).</p> <p>Recently arrived GBM were more likely to consistently use condoms with casual partners and were less likely to report condomless sex protected by PrEP or UVL (Table 1). Recently arrived GBM were more likely to report condomless sex with a risk of HIV acquisition or transmission. Of the 120 recently arrived GBM who reported condomless sex without protection from PrEP or UVL, 113 were HIV negative or untested and not on PrEP, and seven were living with HIV, not on treatment or with a DVL. Recently arrived GBM were less likely to report group sex in the last 6 months, or to use drugs for sex.</p> <p>The multivariable logistic regression model (Table 1) showed that compared with non‐recently arrived GBM, recently arrived GBM were more likely to be born in Europe, or Central or South America, compared with Asia. Recently arrived GBM were younger, more likely to be students and less likely to be in full‐time employment. Recently arrived GBM were less likely to reside in the Australian Capital Territory, South Australia, Tasmania and Western Australia, compared to New South Wales. Recently arrived GBM were less likely to have last tested for HIV at a GP, and more likely to have tested at a hospital, at home or a community‐based service. Recently arrived GBM were less likely to be aware of PrEP, and more likely to report consistent condom use with casual partners. The two groups had similar levels of GSE, likelihood of ever having been tested for HIV, HIV status distribution, sex with HIV acquisition or transmission risk and recent drug use for sex.</p> <hd id="AN0175070918-8">DISCUSSION</hd> <p>We used a national, community‐based sample to compare recently arrived and non‐recently arrived GBM in Australia, focusing on GBM born in non‐English‐speaking countries. We found that recently arrived GBM were more likely than non‐recently arrived GBM to be younger, born in Europe, Central or South America and be students. Recently arrived GBM had lower levels of awareness and use of PrEP, echoing previous Australian research [[<reflink idref="bib6" id="ref41">6</reflink>], [<reflink idref="bib8" id="ref42">8</reflink>], [<reflink idref="bib19" id="ref43">19</reflink>]], and reported similar levels of casual sex with a risk of HIV acquisition to longer‐term residents. Recently arrived migrants were less likely to report HIV testing at services that may incur a cost, like GPs. Our research underscores the need to encourage engagement with HIV prevention and testing in Australia among recently arrived GBM from non‐English‐speaking countries.</p> <p>Recently arrived GBM reported similar levels of lifetime and recent HIV testing to non‐recent migrants. However, recently arrived GBM were more likely to test at locations other than GPs, suggesting that cost and privacy may be issues. Attending GPs may incur a fee (in contrast to sexual health clinics or community services), while testing at home does not require you to ask for a test or explain why you want one. Our findings suggest that it would be useful to publicize services where HIV testing is free or low cost to recently arrived GBM, while also reassuring recently arrived GBM about the confidentiality of HIV testing in Australia [<reflink idref="bib17" id="ref44">17</reflink>]. As nearly one‐third of the recently arrived GBM in our sample were students, university‐based HIV testing promotion strategies also seem warranted [[<reflink idref="bib24" id="ref45">24</reflink>]].</p> <p>Recently arrived GBM reported higher levels of condom use than non‐recently arrived GBM, but lower PrEP awareness and use. They reported a similar level of sex with a risk of HIV acquisition as non‐recently arrived GBM. Previous Australian studies have found that overseas‐born GBM rely on condoms more than other GBM [[<reflink idref="bib6" id="ref46">6</reflink>], [<reflink idref="bib19" id="ref47">19</reflink>]], and may be interested in PrEP, but consider it too expensive without Medicare coverage [[<reflink idref="bib6" id="ref48">6</reflink>], [<reflink idref="bib19" id="ref49">19</reflink>], [<reflink idref="bib26" id="ref50">26</reflink>]]. In our study, recently arrived GBM who were PrEP users were more likely than non‐recent migrants to be personally importing PrEP from overseas, which can be a cheaper way to purchase it [[<reflink idref="bib27" id="ref51">27</reflink>]]. Overseas‐born people may have concerns about PrEP's side effects, effectiveness, lack of protection from STIs and stigmatizing attitudes towards PrEP and PrEP users [[<reflink idref="bib19" id="ref52">19</reflink>], [<reflink idref="bib28" id="ref53">28</reflink>], [<reflink idref="bib29" id="ref54">29</reflink>], [<reflink idref="bib30" id="ref55">30</reflink>], [<reflink idref="bib31" id="ref56">31</reflink>], [<reflink idref="bib32" id="ref57">32</reflink>]]. Our results suggest that recently arrived GBM should be supported to maintain condom use, if that is their preferred strategy, but there is an opportunity to promote PrEP to recently arrived GBM, if they want to use it, particularly through free or low‐cost schemes.</p> <p>There are limitations to our analysis. The GBM we recruited were accessed through community settings and online networks, which means GBM who are more isolated and less socially and sexually active are likely to be underrepresented. Most participants were recruited and completed the survey in English, which excludes GBM with poorer English language skills. The questionnaire uses recall periods of 6–12 months, which may be subject to recall bias. During 2019–2021, the COVID‐19 epidemic caused restrictions on travel and migration, so temporary residents may be underrepresented in the sample. Nevertheless, our research includes the largest sample of overseas‐born GBM analysed to date in Australia, confirming that recently arrived GBM from non‐English‐speaking countries should be prioritized in HIV prevention.</p> <hd id="AN0175070918-9">CONCLUSIONS</hd> <p>Our analysis indicates that recently arrived GBM in Australia report similar HIV risks to non‐recently arrived GBM, more reliance on condoms and less use of PrEP. Lower levels of awareness and affordability appear to be issues for access to HIV services, like PrEP and testing at GPs. It is necessary to enhance access to testing and effective forms of HIV prevention among recently arrived GBM. A range of interventions, including those delivered through university networks, deserve to be considered.</p> <hd id="AN0175070918-10">COMPETING INTERESTS</hd> <p>In the last 3 years, BRB has received payment or honoraria from Gilead Sciences, ViiV Healthcare and FHI 360, and received unrestricted research grants from Gilead Sciences and ViiV Healthcare. DV has received payment made to his institution from Gilead for participation in the HIV Migrant Roundtable. TRB has received payment from Gilead to provide expert feedback at an online workshopping event. For the remaining authors, no conflicts were declared.</p> <hd id="AN0175070918-11">AUTHORS' CONTRIBUTIONS</hd> <p>SY, BRB, TRB, CC and MH contributed to the conceptualization of the topic. SY, CC and TRB contributed to the data curation. SY analysed the data and drafted the paper. JM and TRB helped with data validation. Funding was acquired by SY, BRB, LM, DV, TRB and MH. All authors read, commented on and approved the final manuscript.</p> <hd id="AN0175070918-12">ACKNOWLEDGEMENTS</hd> <p>The authors wish to thank all the GBM who participated in the study, the community organizations which make recruitment possible and the members of the study reference group.</p> <p>Open access publishing facilitated by University of New South Wales, as part of the Wiley ‐ University of New South Wales agreement via the Council of Australian University Librarians.</p> <hd id="AN0175070918-13">FUNDING</hd> <p>The study was funded by the Australian Government Department of Health, China Scholarship Council (No. 202206370055), National Health and Medical Research Council Partnership Project (GNT2002625) and State/Territory Health Departments.</p> <hd id="AN0175070918-14">DATA AVAILABILITY STATEMENT</hd> <p>Deidentified data and syntax used in this analysis will be shared to researchers after a request to the corresponding author.</p> <ref id="AN0175070918-15"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Joint senior authors.</bibtext> </blist> </ref> <ref id="AN0175070918-16"> <title> REFERENCES </title> <blist> <bibtext> Australian Bureau of Statistics. 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  – Url: https://doaj.org/article/de72563d3c614cfb8682a8d691c412ab
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Header DbId: edsdoj
DbLabel: Directory of Open Access Journals
An: edsdoj.72563d3c614cfb8682a8d691c412ab
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PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 984.353637695313
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019–2021
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Simin+Yu%22">Simin Yu</searchLink><br /><searchLink fieldCode="AR" term="%22Benjamin+R%2E+Bavinton%22">Benjamin R. Bavinton</searchLink><br /><searchLink fieldCode="AR" term="%22Curtis+Chan%22">Curtis Chan</searchLink><br /><searchLink fieldCode="AR" term="%22James+MacGibbon%22">James MacGibbon</searchLink><br /><searchLink fieldCode="AR" term="%22Limin+Mao%22">Limin Mao</searchLink><br /><searchLink fieldCode="AR" term="%22Daniel+Vujcich%22">Daniel Vujcich</searchLink><br /><searchLink fieldCode="AR" term="%22Timothy+R%2E+Broady%22">Timothy R. Broady</searchLink><br /><searchLink fieldCode="AR" term="%22Martin+Holt%22">Martin Holt</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: Journal of the International AIDS Society, Vol 27, Iss 1, Pp n/a-n/a (2024)
– Name: Publisher
  Label: Publisher Information
  Group: PubInfo
  Data: Wiley, 2024.
– Name: DatePubCY
  Label: Publication Year
  Group: Date
  Data: 2024
– Name: Subset
  Label: Collection
  Group: HoldingsInfo
  Data: LCC:Immunologic diseases. Allergy
– Name: Subject
  Label: Subject Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22gay+and+bisexual+men%22">gay and bisexual men</searchLink><br /><searchLink fieldCode="DE" term="%22HIV+prevention%22">HIV prevention</searchLink><br /><searchLink fieldCode="DE" term="%22HIV+testing%22">HIV testing</searchLink><br /><searchLink fieldCode="DE" term="%22men+who+have+sex+with+men%22">men who have sex with men</searchLink><br /><searchLink fieldCode="DE" term="%22migrant%22">migrant</searchLink><br /><searchLink fieldCode="DE" term="%22pre‐exposure+prophylaxis%22">pre‐exposure prophylaxis</searchLink><br /><searchLink fieldCode="DE" term="%22Immunologic+diseases%2E+Allergy%22">Immunologic diseases. Allergy</searchLink><br /><searchLink fieldCode="DE" term="%22RC581-607%22">RC581-607</searchLink>
– Name: Abstract
  Label: Description
  Group: Ab
  Data: Abstract Introduction: Overseas‐born gay and bisexual men (GBM) are overrepresented in HIV diagnoses in Australia. We assessed social and sexual behaviours, and the use of HIV prevention and testing, by region of birth and length of residence in Australia. We sought to identify similarities and differences between recently arrived and non‐recently arrived GBM from non‐English‐speaking countries to improve targeting and engagement with HIV testing and prevention. Methods: Data were collected in national repeated, behavioural surveillance surveys conducted across Australia during 2019–2021. Logistic regression was used to identify factors that differentiated between recently arrived (
– Name: TypeDocument
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  Data: article
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  Data: electronic resource
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1758-2652
– Name: NoteTitleSource
  Label: Relation
  Group: SrcInfo
  Data: https://doaj.org/toc/1758-2652
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/jia2.26204
– Name: URL
  Label: Access URL
  Group: URL
  Data: <link linkTarget="URL" linkTerm="https://doaj.org/article/de72563d3c614cfb8682a8d691c412ab" linkWindow="_blank">https://doaj.org/article/de72563d3c614cfb8682a8d691c412ab</link>
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  Label: Accession Number
  Group: ID
  Data: edsdoj.72563d3c614cfb8682a8d691c412ab
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1002/jia2.26204
    Languages:
      – Text: English
    Subjects:
      – SubjectFull: gay and bisexual men
        Type: general
      – SubjectFull: HIV prevention
        Type: general
      – SubjectFull: HIV testing
        Type: general
      – SubjectFull: men who have sex with men
        Type: general
      – SubjectFull: migrant
        Type: general
      – SubjectFull: pre‐exposure prophylaxis
        Type: general
      – SubjectFull: Immunologic diseases. Allergy
        Type: general
      – SubjectFull: RC581-607
        Type: general
    Titles:
      – TitleFull: Assessing HIV risk and the social and behavioural characteristics of gay and bisexual men who have recently migrated to Australia: an analysis of national, behavioural surveillance data 2019–2021
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Simin Yu
      – PersonEntity:
          Name:
            NameFull: Benjamin R. Bavinton
      – PersonEntity:
          Name:
            NameFull: Curtis Chan
      – PersonEntity:
          Name:
            NameFull: James MacGibbon
      – PersonEntity:
          Name:
            NameFull: Limin Mao
      – PersonEntity:
          Name:
            NameFull: Daniel Vujcich
      – PersonEntity:
          Name:
            NameFull: Timothy R. Broady
      – PersonEntity:
          Name:
            NameFull: Martin Holt
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      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 17582652
          Numbering:
            – Type: volume
              Value: 27
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of the International AIDS Society
              Type: main
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