BACKGROUND:Biomedical prevention technologies, such as pre-exposure prophylaxis, treatment as prevention and the principle of Undetectable = Untransmittable, have transformed HIV care and opened new possibilities for enhancing the sexual wellbeing of people living with HIV. Yet, the psychosocial and relational benefits of these tools, particularly their impact on sexual wellbeing, remain underexplored, especially across diverse subpopulations. METHODS:Using data from 669 people living with HIV participating in a large-scale survey of people living with HIV in Australia, this study developed the Sexual Wellbeing through Biomedical Prevention scale, a five-item measure assessing sexual wellbeing (e.g. confidence, enjoyment) in the context of biomedical HIV prevention (score range 0-20; higher scores = greater wellbeing). ANOVA tests examined differences in Sexual Wellbeing through Biomedical Prevention scores across demographic, relational, psychosocial and health-related variables. RESULTS:Exploratory factor analysis supported a single-factor structure. The mean Sexual Wellbeing through Biomedical Prevention score was moderate overall (M = 13.0), but varied significantly by gender, sexuality, relationship status, partner pre-exposure prophylaxis use, stigma and quality of life. Gay/queer men reported markedly higher scores than women and heterosexual participants. Higher scores were associated with partner pre-exposure prophylaxis use, reduced fear of transmission, and better self-reported health and quality of life. Participants who reported 'always' experiencing HIV-related stigma had significantly lower mean scores. DISCUSSION:Biomedical advances have improved virological outcomes, but their sexual wellbeing benefits appear unevenly distributed. Targeted interventions that address stigma, strengthen HIV literacy and support sexual confidence, particularly among women and heterosexual people living with HIV, are essential to realising the full potential of biomedical prevention and advancing equity in wellbeing.

This article queries statistical ways of knowing about “LGBT substance use” and the subject positions they produce. We engage critically with how quantitative knowledge on this topic is generated across social science, psychology and public health and consider its disciplinary effects. This literature reports “higher rates of substance use” among sexual and gender minorities but struggles to explain the disparities it proposes. The most prominent explanation is Ilan Meyer's Minority Stress framework, which conceives substance use as a form of self-medication: a way of coping with the stressors of societal stigma, discrimination, and prejudice. We question whether self-medication adequately encapsulates the characteristic patterns of queer and gender-diverse substance use identified in prevalence studies, suggesting it betrays serious limitations in the professional imagination of psychoactive substances and their uses. Drawing on qualitative research among queer and gender-diverse drug-takers in urban Australia, we argue that the discourse of “disinhibition” gives better expression to their uses of substances to suspend or transform the clutch of heterosexual and gendered norms—an enduring problem for queer and gender-diverse self-formation that given measures of minority stress fail to capture. These uses of psychostimulants have as much to do with energization as self-palliation; connection with others as negative self-coping. The disciplinary effects of psychosocial, quantitative discourse compound the impacts of drugs on individual health, producing people who take drugs as isolated, passive, docile subjects at the expense of registering the part psychostimulants may play in collective activities of queer worldmaking.

OBJECTIVES:Pre-exposure prophylaxis (PrEP) usage remains below the Australian 75% coverage target. This study identified preferences for PrEP services shared among subgroups of men who have sex with men (MSM) living in Australia and explored heterogeneity preferences across different age groups and countries of birth. METHODS:MSM aged>18 years with no prior HIV diagnosis and residing in Australia completed an online discrete choice experiment between May and November 2022. The attributes included type of PrEP, service location, service cost, PrEP side effects, visit frequency and additional services. Participants were recruited through dating apps, Facebook and local MSM community organisations. We used a latent class model (LCM) to explore subgroups with similar preferences for PrEP programmes and a random parameters logit model with interactions to explore heterogeneity preferences. RESULTS:Overall, 1894 MSM participated, with a mean age of 40 (±12) years. The LCM identified four groups of MSM who shared similar preferences for PrEP services: 'Long-acting oral or injectable PrEP from community clinics' (22% of participants), 'Daily oral PrEP from pharmacies' (5%), 'Long-acting oral PrEP from pharmacies' (52%) and 'injectable PrEP from the hospital' (22%). The group preferring injectable PrEP (22%) preferred accessing PrEP services at hospitals offering sexually transmitted infection testing every 6 months, with a willingness to pay a small fee ($A25). They were willing to endure mild pain at the injection site as a side effect of injectable PrEP. Compared with Australian-born, overseas-born MSM preferred PrEP services offering injectable PrEP. Compared with younger MSM, MSM over 30 years old preferred services offering daily PrEP. CONCLUSIONS:There is a growing demand for alternatives to oral daily PrEP, with a significant group preferring services including long-acting oral or injectable PrEP and willing to pay a small fee to access it. The majority preferred decentralising access to PrEP through pharmacies. Diverse preferences for PrEP service delivery signify tailored PrEP implementation initiatives to increase PrEP coverage among underserviced populations.

ABSTRACT:Disparities in HIV-related care and outcomes between people living with HIV (PLWH) who have migrated to Australia and nonmigrants raise concerns regarding equitable access and psychosocial support. Our study explored ways of optimizing HIV services for Asian-born PLWH in Australia, drawing on semistructured in-depth interviews with 18 participants: nine Asian-born PLWH and nine individuals working in the HIV sector. Using reflexive thematic analysis, findings revealed a push and pull between marginalization and empowerment in participants' experiences of HIV care in Australia. Bureaucracy, language, racism, and stigma, as structural and identity barriers, hinder access to support. However, peer-led initiatives, holistic care models, and transnational networks offer hope for sustained service engagement. Community-driven approaches and leadership opportunities were seen as transformative to service provision and policy change. Addressing barriers and promoting culturally affirming care may improve health and well-being outcomes for migrants with HIV. Further research should explore long-term support strategies.

Migrant gay, bisexual, and other men who have sex with men (GBMSM) are a priority population in HIV prevention in Australia. This study sought to understand how social and sexual networks influence sexual health behaviours among migrant GBMSM. Semi-structured interviews were conducted with 27 migrant GBMSM who moved to Australia from 2017 onwards. Interviews were conducted between November 2022 and September 2023. Interviews were analysed thematically. Social and sexual networks impacted participants’ sexual health via two main pathways. Firstly, peers were a source of practical information, such as locations of sexual health services and connecting to LGBTQ+ community health organisations. Secondly, peers and sexual partners modelled HIV/STI testing norms, partner notification of STIs, and use (or non-use) of HIV pre-exposure prophylaxis. Some participants valued having friends with shared identities or similar migration experiences. Others valued support from a diverse range of people after migration, not exclusively linked to LGBTQ+ communities. Participants described various influences in accessing sexual health services, including receiving information through peer networks and influences from norms modelled from peers. However, migrant GBMSM also valued diversity within their peer networks, including peers with various sexual identities, migration experiences, or racial backgrounds. Policymakers and community-based LGBTQ+ organisations should continue working with migrant communities to develop resources that promote the importance of sexual health services. Health promotion and interventions require further adaptation to reach migrant GBMSM who face barriers to connecting with Australian LGBTQ+ communities and networks.

In 2020, there were reports that HIV antiretrovirals, specifically the combination tenofovir disoproxil fumarate and emtricitabine (TDF/FTC), had therapeutic potential for COVID-19. In the context of scant empirical evidence at the time to confirm such an effect, we sought to understand the ways that gay and bisexual men (GBM) made sense of-and embodied-information about HIV antiretrovirals in relation to preventing and/or treating COVID-19. We conducted interviews with 26 participants between August and November 2020. To understand how information about, and experiences of, consuming antiretrovirals might form part of assemblages of COVID-19 prevention for GBM in Australia, we draw on Marsha Rosengarten's (2009) concept of 'informed matter'. 'Informed matter' conceptualises the subject (of disease prevention) as involved in a co-constitutive relationship with the contextual dynamics in which it is situated. Participants drew on their understandings of virology, immunology and pharmaceuticals and experiences with antiretrovirals to form perceptions about their function as therapeutics for COVID-19. By looking beyond biotechnologies as causal of behaviour, we can avoid unintended moralism in contexts of potentially different use. We argue that using 'informed matter' is useful to interrogate, often neglected, complex changes in sex-associated biotechnologies in complicated informational contexts, such as a global pandemic.

This strengths-based study investigated Aboriginal adults' views on young people's sexual health, attitudes and relationships. Between 2019 and 2020, sixteen interviews were conducted with adults aged 25 and older from two Aboriginal communities in Western Sydney, Australia. In this paper, we discuss adults' perspectives on intergenerational communication about sex in their communities. Participants highlighted intergenerational learning via talking as a highly valued community practice and a crucial social-cultural resource for supporting young people's sexual wellbeing. However, they also identified stigma, shame and perceived generational differences as barriers to adults talking openly with younger people about sex. To foster more open intergenerational discussion, participants recommended adopting holistic, positive and non-judgemental approaches when engaging with young people. They also emphasised the need for community-wide initiatives - such as programmes and services - that encourage collective learning, yarning and care to promote positive sexual health outcomes.

Oral HIV pre-exposure prophylaxis (PrEP) is highly effective when taken appropriately at times of HIV risk, termed “prevention-effective adherence”. To understand suboptimal adherence, we refined a brief measure for surveys among gay, bisexual and queer men and non-binary (GBQ+) people. We used a mixed-methods design, comprising a national, online cross-sectional survey (June–July 2023) and cognitive interviews (August–October 2023). Logistic regression identified characteristics of PrEP users who reported condomless anal intercourse with casual partners (CLAIC) that was not protected by their own PrEP use because they missed PrEP doses (“PrEP-unprotected CLAIC”). Cognitive interviews investigated whether the prevention-effective adherence measure was comprehensible. Of 2,046 survey respondents, 792 current PrEP users who had CLAIC in the past 6 months were included (Median age = 37, 86.7% gay, 34.5% non-daily-PrEP users). Of PrEP users who reported any CLAIC, 194 (24.5%) reported any PrEP-unprotected CLAIC. They were more likely to: be < 30 years old, be born in Asia vs. Australia, be part-time vs. full-time employed, use non-daily PrEP, have recently initiated PrEP, have experienced side effects from PrEP, and report recent sexualized drug use. They were less likely to find it easy to get PrEP. The 14 interviewees asked about the survey items (Mean age = 33; 50% gay; ) were able to answer the questions and reliably interpret the content. This first national estimate of prevention-effective adherence found that 24.5% of PrEP users who had CLAIC reported any PrEP-unprotected CLAIC. Targeted interventions in subgroups with more frequent PrEP-unprotected episodes must address side effects and other adherence barriers.

Purpose Significant improvements have been made in Aboriginal and Torres Strait Islander peoples’ (First Nations) maternal and perinatal outcomes over the past decade, such as decreasing rates of smoking and preterm birth and increasing birthweights. In Australia, higher rates of adolescent pregnancy are reported among First Nations compared with non-First Nations people. Having a baby during adolescence (youth pregnancy) increases the risk of poorer maternal and perinatal outcomes, including social outcomes such as poverty and educational attainment. This study examined First Nations peoples’ perspectives about youth pregnancy and parenthood in Western Sydney, Australia. Methods Sixty-eight First Nations people aged ≥16 years living in Western Sydney, Australia were interviewed in 2019–20. Interview data were analysed using thematic analysis. Main findings Approximately half of the participants were aged ≥18 years. Most participants lived with family and around half were high school students. Four themes relating to youth pregnancy and parenthood were identified: 1) youth pregnancy was normalised (e.g. ‘There’s always some young person in [the] community pregnant, if not several… it’s celebrated as well. It’s not so much of a negative thing’); 2) a desire to avoid youth pregnancy (e.g. ‘I think young people try and avoid pregnancy because they don’t wanna be a teen mum’); 3) gendered experiences of youth pregnancy and parenthood (e.g. ‘I don’t think a teenage boy would have like time like for a baby’); and 4) perspectives of caring responsibilities within families (e.g. ‘I feel like within Aboriginal communities, it’s always seen as the oldest kid has to kind of help out the parent’). Principal conclusions Although youth parenthood was acceptable in communities, most participants wanted young people to avoid pregnancy and parenthood. There was a clear community approach to raising children, especially from the oldest children helping out with child raising.

This qualitative study aimed to understand how migration experiences shape wellbeing and quality of life (QoL) for Asian-born men who have sex with men (MSM) who are living with HIV in Australia, and to identify relevant support needs. Drawing from intersectionality theory, this paper reports findings from semi-structured interviews with Asian-born MSM (n = 9), as well as key informants working in the HIV sector (n = 9, total n = 18). Data were analysed using an inductive thematic technique focused on the intersections of structural racism/migration, homophobia/sexuality and HIV/HIV-related stigma. Participants described a multiplicity of ways in which QoL was diminished from their intersecting experiences, including key themes of (i) 'living in limbo' and (ii) 'fear of rejection and disclosure'. However, participants also described positive experiences, such as (iii) the ability to more openly express their sexuality, and a cultivation of self-confidence to advocate for themselves and others ('navigating the politics of belonging'). The findings highlight unique structural and social challenges to QoL that migration and living with HIV can generate. These findings signal a need to redouble efforts within the HIV response to advance QoL for PLHIV in a manner that is affirming, comprehensive and draws on cultural strengths.

COVID-19 saw a rapid shift in how community-based peer support programs were delivered. HIV peer support workers were required to work from home and community-based HIV and LGBTQ + organisations moved their support programs to digital platforms. Between May and September 2020, semi-structured interviews were conducted with individuals who worked (n = 17) or volunteered (n = 4) for community-based HIV and/or LGBTQ + health organisations. Interviews explored the impact of moving to digital service delivery on how peer support programs were delivered and the impact on peer support workers. We identified three overarching themes. Firstly, we highlight challenges with rapidly shifting to online service delivery, particularly as this shift limited opportunities for informal interactions between participants. Informal interactions were considered an important aspect of peer support programs. Secondly, the move to digital service delivery diminished opportunities for informal support between peer workers and their colleagues, just as they were also adjusting to a new and unfamiliar working environment. Thirdly, the removing of physical distance as a specific barrier to care opened new opportunities for engaging potential clients who may have previously had difficulties in accessing HIV support services. We argue that careful consideration is needed to address barriers specific to digital service delivery, including lack of access to appropriate technology and telecommunication infrastructure, as well as concerns about participants' privacy.

Peer support services for people living with HIV (PLHIV) serve varying functions and are a unique resource for support. Peer support programs are considered an important strategy for achieving better quality of life (QoL) for PLHIV and there has been substantial investment in provision of such programs. The present study asks whether being connected to other PLHIV is associated with better QoL for PLHIV in Australia and; whether involvement in formal peer support programs is associated with QoL among people newly diagnosed with HIV. A sample of 816 PLHIV participated in a nationwide survey. Regression analyses showed that having a friend living with HIV who they could talk to about HIV was significantly associated with better QoL. However, a multiple regression analysis showed that use of peer advice/support and peer navigator programs was associated with lower QoL among PLHIV who had been living with HIV for more than five years. This suggests that people experiencing poorer QoL are more likely to access these programs long after diagnosis. It is therefore critical that peer support continue to be available and accessible to PLHIV beyond initial diagnosis and treatment as a means of ongoing HIV-related care.

Gay, bisexual and other men who have sex with men (GBMSM) who use crystal methamphetamine and gamma hydroxybutyrate (GHB) in sexual contexts (otherwise known as chemsex) report barriers to accessing health services. Peer-led chemsex interventions may reduce barriers to care and provide meaningful therapeutic support, however, there have been few formal evaluations of such programs. M3THOD is a novel peer-led intervention based on the transtheoretical model of behaviour change comprising elements of harm reduction education, motivational interviewing and service navigation. In this formative evaluation we appraise the acceptability, appropriateness, and feasibility of M3THOD. M3THOD aimed to support people to reduce chemsex-related harm, manage frequency of chemsex and access specialist services. The acceptability, feasibility and appropriateness of this service were assessed. We collected data from peers’ field notes and conducted 33 semi-structured in-depth interviews. These were conducted with intervention clients (n = 15), eligible community members who did not receive an intervention (n = 9), M3THOD peer workers (n = 3) and their managers (n = 2) and partnering clinicians (n = 4). A thematic framework method was used to analyse data. M3THOD demonstrated acceptability among all stakeholders and was deemed appropriate, with the caveat that peer workers should be supported to operate within a framework of structured flexibility to dually ensure safety and person-centred care. Most participants reported dependence on crystal methamphetamine and desired ongoing rather than one-off peer support. M3THOD’s feasibility was contingent on robust support for training, technical support, and pastoral care for peers, and strong clinical partnerships and referral pathways. M3THOD was valued by participants with unique information and support needs often unmet by sexual health, mental health and drug and alcohol services and reported that peers’ personal experiences of chemsex facilitated rapid rapport, validated and mitigated clients’ shame around chemsex. Our formative evaluation indicated that a peer intervention addressing chemsex is acceptable, appropriate, and feasible in contexts sufficiently resourced to provide substantial support for peer workers. Hiring a team of peer workers, providing training, ongoing coaching, monthly clinical supervision and establishing supportive relationships with co-located counsellors were said to enable the safe and effective delivery of this peer-led chemsex service.

Background The aims of this study were to evaluate the experiences of telehealth for routine HIV care and identify preferred models of HIV routine care for the future. Methods Anonymous, online questionnaire among people living with HIV aged 18years or older. This survey was advertised via posters with a QR code in six sexual health clinics and one community organisation as well as on social media from November 2021 to December 2022. Results Of 89 participants, the majority were males (80/89, 89.9%), between 36 and 55years old (49/89, 55.1%), spoke English at home (74/89, 84.1%), had been living with HIV for >5years (68/89, 76.4%) and reported having a telehealth consultation since the COVID-19 pandemic began (69/89, 77.5%). The top three liked aspects of telehealth were: the convenience of not leaving home or work (50/69, 72.5%); less travel time (48/69, 69.6%); and avoiding contact with other people (30/69, 43.5%). The top three dislikes of telehealth were: they could not be screened for sexually transmitted infections (STIs) or have a physical examination at the same time (29/69, 42.0%); it was an impersonal experience (20/69, 29.0%); and it was more difficult to discuss health concerns (18/69, 26.1%). Among all participants, the preference for future consultations was to have a mix between in-person and telehealth (40/89, 44.9%); however, nearly one-quarter prefer in-person consultations only (20/89, 22.5%). Conclusions Use of telehealth during COVID-19 has been evaluated positively among people living with HIV that participated in this survey. Participants support the use of telehealth for routine care in conjunction with in-person consultations.

Background People living with HIV (PLHIV) have historically faced a range of challenges negotiating satisfying sex lives in the context of virus transmission risks and HIV-related stigma. We examine the experience of sexual satisfaction among PLHIV in an era of pre-exposure prophylaxis (PrEP) and undetectable=untransmissible (U=U)/treatment as prevention. Methods Data are derived from HIV Futures 9, a cross-sectional survey of PLHIV in Australia conducted between December 2018 and May 2019. Logistic regression was used to identify factors associated with sexual satisfaction, including awareness of/engagement with U=U and PrEP as well as experiences that denote HIV-related stigma. Results Over half (56.5%) of the total sample (n = 715) reported they were not satisfied with their sex lives. Those who avoided sex because of their HIV status (44.4%) were more likely to report sexual dissatisfaction, as were those who were aged 50 years or over and those with worse self-reported health. Participants who expressed a concern about their drug use were more likely to report sexual dissatisfaction when compared with those who expressed no such concern. Conclusions Concerns about HIV continue to be present in the lives of PLHIV and can interrupt or undermine intimate and sexual relationships. Although biomedical prevention technologies such as PrEP and antiretroviral therapy may alleviate anxiety relating to onward transmission of HIV, these findings indicate that concerns about HIV status, which may be related to experiences of stigma, are still adversely associated with enjoyment of sex for those living with HIV.

This paper describes the strategies used by Aboriginal young people to build positive relationships and sexual wellbeing. It does so to counter the risk-focussed narratives present in much existing research and to showcase the resourcefulness of Aboriginal young people. We used peer-interview methods to collect qualitative data from 52 Aboriginal young people living in western Sydney, Australia. Participants reported a strong desire to stay safe and healthy in their sexual relationships and to achieve this they relied heavily on oral communication and yarning strategies. Participants viewed communication as a way to gain or give advice (about bodies, infections, pregnancy, relationships); to assess the acceptability and safety of potential partners; to negotiate consent with partners; to build positive relationships; and to get themselves out of unhealthy relationships. Participants also discussed 'self-talk' as a strategy for building sexual wellbeing, referring to narratives of self-respect and pride in culture as important in establishing Aboriginal young people's positive views of self and as deserving of respectful and safe sexual relationships. These findings suggest that future programmes and interventions based on yarning could be well-regarded, given it is a cultural form of pedagogy and a strategy Aboriginal young people already use to build positive relationships and identities.

Introduction: HIV preexposure prophylaxis (PrEP) is highly effective at preventing HIV. We aimed to assess mental and physical health among long-term PrEP users in Australia's X-PLORE cohort. Methods: In early 2021, 1485 X-PLORE participants were emailed a survey covering demographics, sexual practices, ongoing PrEP use, physical and psychological diagnoses received since commencing PrEP, substance use, and impacts of the COVID-19 pandemic. Current anxiety and depression were assessed using GAD-7 and PHQ-9 questionnaires. Results: Of 476 participants (completion rate 32.1%), 99.8% were cis-gender men. Median PrEP use duration was 48 months (2002 person-years), with 81.7% currently using PrEP. PrEP-related toxicity was uncommon: 2.9% reported bone fractures, 1.3% low bone density, and 4.0% reported kidney problems, largely not necessitating PrEP cessation. Most (92.0%) rated their health as ‘good’ to ‘excellent’, and 22.6% reported improved health since starting PrEP, often because of improved mental health. Only 6.2% reported deterioration in health since starting PrEP, largely unrelated to PrEP. The most common diagnoses were hypertension (9.9%), depression (13.2%) and anxiety (14.9%); 17% had PHQ-9 scores indicating current moderate-to-severe depression, which was associated with unemployment [adjusted odds ratio (aOR) 3.90], regular cannabis use (aOR 2.49), and having ceased PrEP (aOR 2.13). Conclusion: Among long-term PrEP users, of which over 80% were currently using PrEP, self-reported PrEP toxicity was uncommon. With almost one in five PrEP users categorized as having depression, and with higher risk among those having ceased PrEP, we recommend routine screening for depression and anxiety in PrEP users and corresponding follow-up of patients no longer attending for PrEP.

The COVID-19 'hard lockdowns' in Melbourne, Australia in 2020 targeted public housing estates thus trading on perceptions of risk associated with public housing as some of the most stigmatised sites in post-industrial cities. This article draws on interviews with Melbourne public housing tenants on their experience of COVID-19 lockdowns to analyse the place of stigma in residents' accounts. Pairing Wacquant et al's (2014) concept of 'territorial stigma' with sociological work on the biopolitics of stigma we consider the dynamics of stigma, tracing how it functions to delimit community boundaries and justify pandemic containment measures. Residents navigate multiple layers of stigma, including stereotypes of public housing, normative judgements of neighbouring residents, and a broader public housing system riven with structural issues. Members of these communities are both the targets of stigma and seek to distance themselves from those seen as vectors of stigma. Our participants report mobilising social distancing strategies couched in normative assessments of perceived risk based on physical appearance, presumed drug use and past conduct. We explore the implications of these enactments of territorial stigma and trace the logics of abjection that construct public housing as deprived urban zones, home to abject 'Others' perceived as threatening the health of the community.