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Background Gay and other men who have sex with men of Asian background (GAM) have been identified as a key population in efforts to eradicate HIV in New South Wales. The aims of the present study were to evaluate current levels of engagement with HIV and sexually transmissible infection (STI) testing services, assess knowledge of pre- and post-exposure prophylaxis and to identify factors associated with service engagement in this group. Methods: A survey of 604 GAM residing in Sydney and Melbourne was undertaken. Results: The data identified that a significant proportion of non-HIV-positive men (i.e. HIV-negative men and men whose HIV status was unknown) surveyed (n = 567; 93.9%) had engaged in frequent HIV testing and comprehensive STI testing in the 12 months prior to the survey (n = 180; 31.7%). There were significant differences (P < 0.05) in sexual practices at the bivariate level between those who reported frequent and comprehensive HIV/STI testing and those who did not. Those who tested regularly were substantially more sexually active, were more likely to have multiple partners (P = 0.001) and were more likely to engage in condomless anal intercourse with both casual (P < 0.001) and regular (P = 0.002) partners. Those who engaged with testing initiatives were more likely to discuss HIV status with both regular (P = 0.008) and casual (P < 0.001) partners, and identified more reasons to test than their counterparts (P < 0.001). The data also highlighted key service venues, with gay men most likely to have used public sexual health clinics (46.9%) as their most recent testing venue. Conclusions: The data demonstrate an association between high levels of male-to-male sexual activity and engagement in frequent and comprehensive HIV and STI testing. This likely derives from both self-perceived notions of risk and current reliance on established gay community organisations to convey information around testing. Increasing engagement with testing initiatives beyond GAM who self-identify as being at high HIV and STI risk will require the use of novel routes by which to disseminate this information.

Background Routine HIV clinical monitoring is vital for people living with HIV (PLHIV) after treatment initiation. The relationship between clinical visits during the first 6 months after initial antiretroviral therapy (ART) and long-term, HIV-related mortality and service retention was investigated. Methods: A retrospective ART observational research database was established based on de-identified data extracted from 6959 records of adult HIV-positive registrants held by Hunan CDC (Center for Disease Control and Prevention) between 2003 and 2013. Results: During the first 6 months of initiation into ART, 2364 (34.0%) of PLHIV had completed four scheduled visits, meeting the Chinese ART clinical monitoring standards. From 6 months onwards (up to 36 months), this group had the lowest HIV-related mortality (4.4%) compared with those who had more or less than four kept visits in the first 6 months [one visit only: adjusted hazards ratio (AHR) = 3.15, 95% CI 2.24–3.88; two visits: AHR = 2.24, 95% CI 1.80–3.01; three visits: AHR = 1.86, 95% CI 1.69–2.05; and >4 visits: AHR = 1.37, 95% CI 1.11–1.72]. Those with less than three kept visits were also at increased risk of cohort loss to follow up (ART discontinuation, prolonged service disengagement or death). A myriad of personal, clinical and social factors are identified to be associated with increased HIV-related mortality and clinical retention. Conclusions: Enabling PLHIV to complete four scheduled clinical visits during the first 6 months of ART initiation, as recommended by the Chinese CDC, is critical.

Background: In recent years there has been an increase in the incidence of acute hepatitis C virus (HCV) in men who have sex with men (MSM). The aim of the present study was to examine the prevalence of HIV/HCV co-infection among MSM in Sydney, and to compare sexual and drug use risk practices of HIV/HCV co-infected MSM with HIV and HCV mono-infected MSM. Methods: Data were collected from gay and other homosexually active men as part of the ongoing Gay Community Periodic Surveys (GCPS). The analysis herein presents findings from the Sydney GCPS in August 2011, which collected data on HCV for the first time. The survey was completed by 2009 respondents. Results: Three per cent of respondents self-reported being HCV positive (representing 9.0% of HIV-positive men and 1.9% of HIV-negative men). Overall, 1.2% of respondents reported being HIV/HCV co-infected. HIV/HCV co-infected men were more likely than HCV or HIV mono-infected men to report several sexual and drug use practices that may increase the risk of blood-borne virus transmission. Conclusions: Consistent with other research, we found a higher prevalence of HCV among HIV-positive than HIV-negative men. Several risk practices were more commonly reported among HIV/HCV co-infected men. These findings, and the increasing incidence of HCV in MSM, reinforce the need for routine HCV screening in this population.

The relevance of circumcision in preventing HIV male-to-male sex transmission is poorly understood, in particular because any potential effect could be obscured by sexual practice as a mediating or confounding factor. Using data from the Health in Men (HIM) cohort of 1426 HIV-negative homosexually active men in Sydney, we compared the sexual practices and sexual experiences of circumcised and uncircumcised men. Overall 66% of men (n�=�939) in the cohort were circumcised. After adjusting for age and ethnicity, we found no difference between circumcised and uncircumcised men in anal sexual practices, difficulty using condoms, or sexual difficulties (e.g. loss of libido). Among the circumcised men, we compared those circumcised at infancy (n�=�854) with those circumcised after infancy (n�=�81). The majority cited phimosis (i.e., an inability to fully retract the foreskin) and parents' decision as the main reasons for circumcision after infancy. After adjusting for age and ethnicity, men circumcised after infancy were more likely to practise receptive anal sex (88% vs 75%, p�

Male circumcision may reduce the risk of HIV acquisition in heterosexual men. In observational studies, confounding by demographic factors could produce spurious associations between circumcision and HIV risk. To assess this possibility, cross-sectional data on self-reported circumcision status and demographic factors were collected at baseline as part of the Health in Men study. Two-thirds of 1426 subjects were circumcised, mostly in the neonatal period. In multivariate analyses, age, ethnicity and country of birth were independently associated with circumcision status. Confounding by these demographic factors must be considered in future epidemiological studies addressing circumcision and HIV acquisition.