National Centre in HIV Social Research
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HIV and Sexual Health

condoms2.jpgNCHSR’s HIV and Sexual Health research program aims to:

  • produce social research of the highest standard that contributes to our understanding of the social and behavioural factors that influence the contexts of HIV and sexual health within Australia.
  • conduct studies of the individual, interpersonal and cultural impact of HIV and other sexually transmissible infections on those directly affected, their carers and their communities; and to identify appropriate strategies and health care models to deal with these issues.
  • facilitate the development, implementation and evaluation of effective prevention strategies through robust research and to identify the barriers to their adoption by those at risk of HIV
  • participate as a partner in developing and evaluating effective government and community-based policy and program responses relating to HIV and other sexual health issues both within Australia and internationally.

MardigrasIn the area of HIV and Sexual Health, NCHSR’s research focus is on groups and populations most at risk of infection and identified in the Australian Government’s National Strategies. Researchers in the program are able to employ different research methods and to work across disciplines. The work of the program ranges from behavioural surveillance and longitudinal cohorts to detailed qualitative studies and critical reviews of primary sources. Our approach is premised on the belief that good social research and appropriate program and policy responses require detailed understandings of social settings, cultures and the contexts in which sexual transmission of HIV and other infections occur.

Current projects

Selected past projects

Contacts

For more information please contact Professor John de Wit, Head, HIV Program.

Project descriptions

Gay community periodic surveys

Zablotska, Hull and Frankland

The gay community periodic surveys are funded by state and territory health departments and conducted jointly by NCHSR and the National Centre in HIV Epidemiology and Clinical Research in collaboration with state AIDS councils. The first periodic survey of gay men’s sexual practice was conducted in Sydney in February 1996 and the survey has been repeated every six months since then. Gay community periodic surveys are now conducted regularly in other states as well, annually in Melbourne and Brisbane, every other year in Adelaide and Perth, and every three years in Canberra. In 2007 these surveys took place in Melbourne, Brisbane, Adelaide and twice in Sydney (in February and August).

These data provide useful monitoring of self-reported HIV status and changes in the sexual practice and drug use of gay men. The results of each survey are presented in an individual report, which in 2007 were standardised to allow each state report to be compared directly with every other. NCHSR also continued to produce and distribute brochures to provide feedback to study participants on the Sydney and Queensland survey data. These brochures were jointly produced by NCHSR, ACON and the Queensland Association of Healthy Communities. Discussions are currently taking place with other states about introducing such an initiative.

The role of the internet in building social capital among homosexually active men: virtual communities in HIV prevention (e-male study)

Kippax, Worth, Rawstorne and Holt

This study, funded by the ARC’s Linkage scheme, investigates whether the internet increases social capital among men who have sex with men (MSM) by building social connections and a sense of belonging; and whether such ‘virtual’ communities facilitate the uptake of internet-based HIV prevention and other health promotion messages and their translation into safe sex practice. Social capital comprises features of social organisation such as civic participation, norms of reciprocity and trust in others that facilitate cooperation for mutual benefit, including health and well-being. The study explores the potential benefits as well as harms to those homosexually active men who use the internet to access health information, meet sexual partners and build friendships that affirm gay identity and community inclusion. The study has also assessed whether an online methodology is useful for reaching men living in rural and remote areas, and whether the methodology could replace or complement the current print-based periodic surveys of gay men in major cities.

Between February and April 2008, the main project survey was conducted online at the project website, www.e-male.com.au. Over 4,000 men were attracted to and completed the online survey. The survey attracted a diverse range of MSM, including notably high proportions of young and bisexual men, men from regional areas and those who had never been tested for HIV. A project report has been published and can be downloaded here (PDF) (1 Mb). The project team is currently focusing on peer reviewed publications.

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HIV General Practice Workforce Project

de Wit, Newman, Reynolds and Kippax

The number of people living with HIV/AIDS in Australia is increasing and ageing, requiring an expert primary care workforce to provide HIV clinical care into the future. Yet the numbers of GPs training as s100 prescribers may be insufficient to replace those leaving to retire or change jobs. NCHSR is leading a new study to provide critical and timely evidence for why and how GPs pursue or continue careers in HIV in different caseload and geographical settings across Australia.

Funded by the National Health and Medical Research Council, the aims of this three-year study are to:

  1. To identify the key factors that influence the decision of Australian general practitioners (GPs) to pursue or continue careers in HIV clinical care, given the increasing number and age of people living with HIV/AIDS (PLWHA) in Australia;
  2. To compare the professional interests and aspirations of GPs who have worked in HIV medicine for various lengths of time;
  3. To examine barriers and incentives to providing HIV care in different primary care settings, including in areas of high and low HIV caseloads, and in urban and regional Australia.

In achieving these aims, it is hoped the findings of this study will also produce new knowledge on the role of GPs in maintaining and enhancing the health of PLWHA in Australia.

A broad and multidisciplinary team of Investigators has been brought together to work on this important topic, including HIV, general practice and social researchers, general practitioners and people living with HIV. Organisations represented in the research team include UNSW, Flinders University, NAPWA, ASHM, AFAO and the Royal Australian College of General Practitioners.

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Feasibility of an national internet-based cohort study of men who have sex with men in Australia

Imrie, Zablotska and De Wit

This project involves undertaking the initial preparatory logistical and methodological development work to determine the feasibility of establishing an internet-based cohort and repeat cross-sectional research program among homosexually active men in Australia.

Concern about rising HIV notifications, diverging HIV epidemics between jurisdictions and increasing STIs have prompted a wholesale rethink of the role of behavioural surveillance. A national internet-based platform combining both longitudinal and repeat cross-sectional studies would be unique and have the added benefits of linkage to national and state registers providing incidence data on HIV/STIs and other health conditions (e.g. cancer, mental illness, etc) and potentially the use of health, pharmaceutical and social care services. The platform would also allow comparisons between states/territories, and with the general male population. Obvious challenges include participant retention and stratified sample-size in small states. But in this new territory there are also new issues - multi-level inter-sectoral collaboration, evaluation design, ethics, consent requirements, governance and data management (e.g. confidentiality, handling and ownership). This study will investigate the feasibility of a national internet-based research platform and make recommendations to possible funders about the viability of adopting this approach.

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The straightpoz study: heterosexual men and women living with HIV

Persson

The aim of this study is to identify and explore issues significant to men and women living heterosexually with HIV in New South Wales.

The Straightpoz study is a qualitative longitudinal cohort study that explores the experiences of living with HIV of heterosexual men and women with HIV and their sero-negative partners in New South Wales. The study is conducted in collaboration with Pozhet, the Heterosexual HIV/AIDS Service NSW. This study, the first of its kind in Australia, explores experiences of living with HIV that are specific to this group, as well as experiences specific to men, women and serodiscordant couples respectively. The first round of interviews was completed in 2005, focusing on diagnosis, identity, stigma, disclosure, relationships, sexuality, social connectedness and contact with services and the broader positive community. A second round of interviews was completed in 2007, focusing on issues around health and treatments, interactions with health professionals, sexual practices, sexual health and understandings of sexual risk and transmission. A third and final round of data collection is currently being conducted.

The findings of this research study provide a basis for considered development of appropriate service provision for those living heterosexually with HIV and will also increase understanding of the intersections of sexuality, gender and illness. The first research monograph based on this study, Men and women living heterosexually with HIV: the Straightpoz study, Volume 1 (PDF) (587 Kb), was launched in late 2006. The second research monograph was released in early 2009, Men and women living heterosexually with HIV: the Straightpoz study, Volume 2 (PDF) (1 Mb). Other publications from this study can be found on the NHCSR web site. Other dissemination of findings is ongoing.

Who's calling? An analysis of calls made to the Pozhet info-line from 1993 to 2007

Zablotska and Persson

HIV-positive heterosexuals in Australia often experience HIV in relative secrecy because of the stigma attached to having the virus. This makes it difficult for them to find out about and to access support. Pozhet was established in 1993 to address the particular needs of HIV-positive heterosexuals; one of the services it offers is an information phone line. Since the establishment of the info-line, there has been an average of about 400 callers each year. In 2007 the data from call records collected from 2003 to 2006 were systematically reviewed by a trained coder and re-entered using a new-caller record form. All incoming calls in 2007 were also registered using the new-record form.

In 2008 the data from these systematised records will be analysed quantitatively to glean information about the needs of HIV-positive heterosexuals and their partners, friends and families. Findings from this study will assist Pozhet and other service providers to plan better health care and support for heterosexuals with HIV. In 2008 funding will be sought for data analyses and production of feedback materials.

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Barriers to HIV testing among people from culturally and linguistically diverse backgrounds

Körner, Asante and Kippax

This project investigates the reasons for delayed HIV testing, particularly among people from culturally and linguistically diverse backgrounds. The project has two components, one quantitative, the other qualitative. The quantitative component collects demographic and socio-economic data, along with data about people’s use of health services, attitudes towards HIV and perceptions of stigma. These will be linked with the patients’ HIV-related clinical data to identify patients who were diagnosed late and the reasons for their late diagnosis. The qualitative component follows up the survey and approximately 20 HIV patients from culturally and linguistically diverse backgrounds are interviewed. These interviews explore in depth some of the issues covered in the survey, in particular issues relating to patients’ use of health services. Ethics approval for the project was obtained from the UNSW Ethics Committee and area health services. Data collection was completed in 2007. The project will be completed in 2008.

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Periodic survey of knowledge and perceptions of HIV and the use of HIV services among people from priority CALD communities in New South Wales

Körner, Asante and Kippax

The aim of this study is to investigate knowledge and perceptions of HIV and the use of health services among the general populations of four ethnic communities in Sydney that have a high prevalence of HIV infection: the Thai, Cambodian, Sudanese and Ethiopian communities. The study investigates people’s knowledge and use of health services in Sydney; patterns of movement between Australia and their country of birth; knowledge about and perceptions of HIV, including HIV transmission and living with HIV; and the manner in which people living with HIV are perceived within these four communities, including their experiences of stigma and discrimination. Data collection was completed in 2007. The project will be completed in 2008.

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Respondent-driven survey of sexual behaviours among gay men in Sydney, Australia: a pilot study

Zablotska

The aim of this study is designed to test (1) the feasibility and effectiveness of respondent-driven sampling (RDS) for further implementation in the prospective studies in Australia; (2) the representativeness of the RDS sample, and (3) the new data collection instrument.

HIV/STI risk behaviour of gay men has been well-studied, but networks of gay men and how they affect men’s HIV risk are less well understood. This project aims to pilot test among Australian men a new data collection methodology – respondent-driven sampling. The study will recruit 100 men in Sydney using chain referral and the rationed referral approach.

Supplementary funding has been requested from NSW Health to enrol an additional 200 men. This will allow statistical analyses of data and will enable a quantitative comparison of samples obtained by traditional convenience and RDS sampling. If successful, this recruitment methodology will be further used in multi-centre studies of gay men’s networks.

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Understandings of risk and HIV among men who have sex with men (MSM) in Victoria, Queensland and New South Wales

Imrie

This is a coordinated study of risk and HIV among MSM in Victoria, Queensland and New South Wales. The study will examine risk factors for HIV seroconversion in different contexts using data from men recently tested positive for HIV and believed to be recent seroconverters. The second component will look at risk motivations among MSM deemed to be at high risk for HIV, and focus on attitudes and understandings.

The past few years have seen some significant variations in numbers of new HIV diagnoses and different HIV risk practices in different jurisdictional contexts. The aim of this study is to examine these different risk contexts across different jurisdictions to better understand the mechanisms of risk as well as the attitudes and understandings of risk in MSM who would appear to be at elevated risk of HIV seroconversion.

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Living with uncertainty: creating the postmodern self in contemporary Australia

Reynolds

The aim of this study is to gauge how well individuals are negotiating the uncertainties and choices of postmodernity. What are the opportunities and dangers of postmodern life? What strategies are Australians formulating in an era of dissolving truths? What are the distinctive pressures and stresses of inhabiting a post-traditional world? Above all, how well equipped are contemporary Australians to find answers to the postmodern question: how are we to live?

These questions will focus on a case study of a particular social group: gay men. This population is especially apposite for an analysis of the self in postmodernity. As a social category and as an individual identity, being homosexual is a relatively recent invention. The objective of this project is thus to study the everyday practices and beliefs that make up a sense of self in gay subcultures, especially as they pertain to emotional life. In 2007 the data and analysis from this project was written up as a monograph and published by UNSW Press under the title, What happened to gay life.

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Past project descriptions

Qualitative Interviews Concerning Key Issues and Experiences (QUICKIE) project

Holt, Race and Bernard

The QUICKIE project was a two-year study (from 2006 to 2008) funded by NSW Health. In 2007 and 2008 around 30 sexually active, community-attached gay men were interviewed in Sydney about their relationships, sex and drug practices, engagement with social scenes, health and well-being, experiences of clinical services, and views on the personal, social and political aspects of being gay in Sydney. In providing an annual qualitative snapshot of ‘ordinary’ gay men’s lives, the project complemented data from NCHSR’s behavioural surveys. Each year, the QUICKIE interviews had a special focus. In 2007 the focus was the significance of HIV in Sydney and in 2008 it was the perception and experience of sexually transmissible infections.

A report of the 2007 findings, Accounts of contemporary gay life in Sydney: Summary of findings of the QUICKIE study, 2007 (PDF) (372 Kb), was published in early 2008. Fact sheets on gay men’s use of Viagra (PDF) (153 Kb) and the perception and experience of sexually transmissible infections (PDF) (156 Kb), alcohol use (PDF) (210 Kb) and the perceptions of partner numbers (PDF) (288 Kb) are also available.

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Primary Health Care Project on HIV and Depression

Kippax, Mao, Newman and Körner

Running from 2006-2009, this three-year project adopted a comprehensive and multi-method approach to investigate the prevalence, nature, clinical management and self-management of depression among men, particularly homosexually active men, attending high HIV-caseload general practice clinics. The study aimed to: 1) describe, measure and compare depression among HIV-positive and HIV-negative gay men; 2) describe the ways in which depression is managed by general practitioners (GPs) and gay men themselves; and 3) develop the research capacity and skills of GPs to assess and manage depression among gay men. Extensive data were collected through interviews and surveys involving over 30 general practitioners and more than 700 men seeking services from seven high HIV-caseload general practices in Sydney, Adelaide and a rural-coastal town in New South Wales.

A list of the main publication and other outputs from the study is available here.

Health in men (HIM) cohort study

Kippax, Crawford and Mao

An open cohort enrolling approximately 500 HIV-negative gay men per annum was established in Sydney in July 2001 to monitor risk practice and HIV incidence in the context of vaccine initiatives. By December 2004, 1427 men had been recruited into the study and the project stopped recruiting new participants. The study examines risk from sexual behaviour and drug use, beliefs and understandings of prophylactic and therapeutic vaccines, expectations of vaccines, and motivations for taking part in vaccine trials. Data are collected on the nature of sexual relationships, HIV status of respondents and their partners, sexually transmissible infections, HIV optimism–scepticism, and reported hepatitis A, B and C infections. The aims of the study are to establish a baseline of risk practice among potential vaccine trial participants and to inform community-based organisations and other agencies engaged in health promotion about men’s current understandings of vaccine initiatives. The study is conducted by NCHSR in collaboration with the National Centre in HIV Epidemiology and Clinical Research, the Australian Federation of AIDS Organisations and the AIDS Council of NSW (ACON). Between 2002 and 2005 around 80% of the men recruited into the cohort had been followed up. An 18-month extension of the study starting from January 2006 was funded by the National Health and Medical Research Council. In 2006 NCHSR published a joint report presenting data from both the Positive Health (see page 15) and HIM cohorts to provide a more comprehensive analysis of sexual health and general well-being of HIV-positive and HIV-negative gay and homosexually identified men in Sydney.

The report, The Health in Men and Positive Health cohorts: A comparison of trends in the health and sexual behaviour of HIV-negative and HIV-positive gay men, 2002-2005 (PDF) (720 Kb), was published in 2006. The study team is now focusing on the determinants of HIV seroconversion and other sexually transmissible infections (STIs) and the role played by STIs in the transmission of HIV.

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Positive health: HIV-positive men who have sex with men

Zablotska and Kippax

The Positive Health study is an open cohort study of HIV-positive gay and other homosexual men living in New South Wales. The study focuses on HIV testing and markers of health, treatment and care, sexual practices and attitudes, sexual health testing and other issues. A major goal of the study is to assess the lived experience of HIV-positive people over time. Participants are recruited in clinics and community groups of HIV-positive people in urban and rural settings and are interviewed annually. In 2007, the last year of data collection, the study recruited 230 participants and testing for sexually transmissible infections was offered to all participants for the third consecutive year. Expanded data analyses are being carried out and publications submitted to journals.

This study has been conducted in collaboration with the National Centre in HIV Epidemiology and Clinical Research, the Australian Federation of AIDS Organisations and the National Association of People Living with HIV/AIDS. Reports from this study are available on the NCHSR website.

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The making of HIV and heterosexuality in the mainstream Australian print media

Newman and Persson

This project was funded by a UNSW Faculty Research Grant to explore the role of the mainstream media in the production and circulation of social and cultural knowledge about HIV, and as an important source of information about HIV for the broader population in Australia, those not explicitly targeted by HIV prevention campaigns.

The results of this short project include: a review of the Australian and international literature available on HIV and the media; an electronic archive of the full text of all newspaper articles relating to HIV published in The Sydney Morning Herald from 2000 to 2005; a basic content analysis of these articles (date, author, genre and topic); and an in-depth discourse analysis of selected articles, focusing on themes, metaphors and narratives. Two peer-reviewed journal articles were published from the findings in early 2008.

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