The development of an HIV risk reduction framework for gay and other men who have sex with men (MSM) in New South Wales, Australia

Published: July 21, 2010

R. Sutherland1, G. Prestage2,3, R. Lake4

1ACON / Aids Council of New South Wales, Education, Sydney, Australia, 2University of New South Wales, National Centre in HIV Epidemiology & Clinical Research,, Sydney, Australia, 3La Trobe University, Australian Research Centre in Sex Health and Society, Melbourne, Australia, 4Positive Life NSW, Sydney, Australia

Issues: Gay men continue to incorporate changes in HIV transmission risk knowledge into their HIV risk reduction strategies (RRS). Under certain conditions, serosorting, the use of viral load, strategic positioning, and negotiated safety can each reduce the risk of HIV transmission when compared to unprotected anal intercourse (UAI) without any RRS.
Description: To ensure that HIV prevention knowledge and practice reflects these developments, a risk reduction framework has been developed by ACON and Positive Life NSW. It acknowledges that the effective use of RRS is contextual, can be impacted by drug and alcohol use, mental health, differential levels of knowledge and sexual negotiation skills, and HIV-related stigma. It recommends maintaining consistent condom use for anal intercourse with casual partners overall, while developing targeted interventions that acknowledge and inform RRS among some men.
The framework does not support strategic withdrawal as an effective strategy, promotes negotiated safety as relevant to UAI with regular partners only and considers the promotion of ‘probable HIV negativity’ disclosure in addition to the disclosure practices of HIV positive men.
Key performance measures are also outlined in the framework for evaluation purposes.
Lessons learned: Consultation with stakeholders was required to consider the transition from a ‘100% condom use’ model for HIV prevention to a targeted ‘condoms when necessary’ model.
There are also significant implementation challenges for a framework which requires targeted messaging for a particular sub-group while maintaining general condom reinforcement overall. Therefore, a broad communication strategy is essential to explain its rationale and relevance.
Next steps: This framework provides the basis for a consistent approach to RRS in future HIV prevention work and an important policy context for government and community partners. It has broad implications for an increasingly nuanced approach to HIV prevention addressing the effective use of RRS in jurisdictions that have significant male to male HIV transmission.

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