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Pre-exposure prophylaxis (PrEP) has been rapidly rolled out in large, publicly funded implementation projects in Victoria and New South Wales, Australia. Using behavioural surveillance of gay and bisexual men, we analysed the uptake and effect of PrEP, particularly on condom use by gay and bisexual men not using PrEP.

Frequent testing of individuals at high risk of HIV is central to current prevention strategies. We aimed to determine if HIV self-testing would increase frequency of testing in high-risk gay and bisexual men, with a particular focus on men who delayed testing or had never been tested before.

ObjectiveAssess willingness to use HIV pre-exposure prophylaxis (PrEP), support for others using it and willingness to have sex with partners using PrEP among Australian gay and bisexual men (GBM).MethodsNational, online cross-sectional surveys of Australian GBM were conducted in 2011, 2013 and 2015. Scales measuring support for and willingness to have sex with men using PrEP were developed in 2015 using factor analysis. Trends and associations with key measures were analysed using multivariate logistic regression.ResultsDuring 2011–2015, 3850 surveys were completed by GBM. Willingness to use PrEP among HIV-negative and untested men did not change between 2011 (28.2%) and 2015 (31.7%, p=0.13). In 2015, willingness to use PrEP was independently associated with younger age, having an HIV-positive regular partner, recent condomless anal intercourse with casual male partners (CAIC), more than 10 male sex partners in the previous 6 months, ever having taken postexposure prophylaxis and having fewer concerns about using PrEP. In 2015, 54.5% of GBM supported other GBM taking PrEP and 39% were willing to have sex with men using PrEP. Support for and willingness to have sex with PrEP users were both associated with being HIV-positive, having a university degree and having two or more male partners in the previous 6 months. Willingness to have sex with men on PrEP was also associated with recent CAIC and using party drugs for sex, but was less likely among men who consistently used or had a positive experience using condoms.DiscussionInterest in and support for using PrEP are concentrated among men who engage in higher risk practices and who know more about living with HIV. This is consistent with the targeting of PrEP in Australia.

In recent work on environmental and health risks, Isabelle Stengers has suggested that governing logics have been seized by a strange injunction: “the right not to pay attention.” She characterizes “paying attention” as an art that brings into play connections we are in the habit of keeping separate. In this article, we use this insight to characterize different forms of prevention in the drugs field, arguing that “modes of attention” are an important consideration for harm reduction and counterpublic health. Our case study centers on the ACON Rovers, a team of volunteers who rove around gay dance events on the lookout for people in trouble. Through certain “arts of interception” and through an immanent practice of working with possibilities, the Rovers aim to avert certain dangers, especially those associated with use of the drug gamma-hydroxybutyric acid. But doing this work well involves a certain mode of attending to risk, derived from embodied knowledge, that has regard to the affective relations of surveillance. In this article, we seek to describe and theorize the work of the ACON Rovers. We discuss the historical emergence of the program, the forms of knowledge it draws upon and mobilizes, the attention the project pays to affective relations between different actors in the party environment, and the mechanisms the project has installed to assess and reflect upon its work. Since they seek to intervene in drug effects, we argue that the Rovers are engaged in ontological work. Their mode of operation can be contrasted with that of drug enforcement, which often assumes “the right not to pay attention.”