Martin Holt (NCHSR) discusses the findings of the Gay Periodic Surveys and concludes that support services will increasingly face ageing and sexuality issues with HIV-positive gay men, and that tradtionally oriented services may find it harder to engage with HIV-negative gay men. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.

1. How are HIV-negative and HIV-positive gay
men changing over time and what does it mean
for health promotion? Martin Holt, Evelyn Lee, Garrett Prestage,
Iryna Zablotska, John de Wit, Limin Mao
National Centre in HIV Social Research

2. Rationale
• Gay men are not a static population; their social
and sexual relationships (with each other &
other people) change over time
• This challenges health promotion and HIV
prevention in:
– Understanding gay men as a target group
– Identifying their needs
– Reaching out and engaging gay men
• The Gay Community Periodic Surveys provide a
mechanism to monitor changes over time.

3. Analysis
• A comparison of HIV-negative and HIV-positive
men in 2000/01 and 2008/09:
– Comparing negative and positive men within each
time period
– Comparing neg-neg and pos-pos over ten years
• Allowed identification of shared changes and
those specific to each group
• Data from all GCPS were included
(ACT, NSW, QLD, SA, VIC, WA)
• A total of 21,620 responses were analysed.

4. Mean age (in years)
50
45
42.1
40 39.2
35 34.9 35.7
30
25 HIV-positive men are significantly older in both periods HIV-positive
(p<0.001). HIV-negative
20
15 The age difference is growing over time.
10
5
0
2000-2001 2008-2009

5. Paid employment
100% HIV-negative men are significantly more likely to have paid work in
both periods (p<0.001). However, the gap has closed over time.
82% 81%
80%
70%
66%
60%
HIV-positive
40% HIV-negative
20%
0%
2000-2001 2008-2009

6. University education
100%
HIV-negative men are significantly more likely to have a
university degree in both periods (p<0.001).
80%
There has been a dramatic increase in university
participation over time in both groups.
60%
However, the gap has widened over time. 53%
HIV-positive
42%
40% HIV-negative
24%
20% 17%
0%
2000-2001 2008-2009

7. Extensive social engagement with gay men
HIV-positive men are more likely to have gay friends and spend time
with gay men in 2000-2001 (p<0.01) and 2008-2009 (p<0.001).
100% 95% 93%
The decline in social
81% engagement is
80% much greater
73%
among HIV-negative
men.
60%
HIV-positive
40% HIV-negative
20%
0%
2000-2001 20008-2009

8. 10+ partners in last 6 months
100%
HIV-positive men are more likely to have 10+ partners in the six
months prior to survey in both periods (p<0.001).
80%
There have been declines in no. of partners in both groups over
time, and both groups have become more similar.
60%
HIV-positive
42%
40% HIV-negative
34%
27%
23%
20%
0%
2000-2001 2008-2009

9. Men in seroconcordant relationships
100% HIV-positive men are less likely to be in a seroconcordant
relationship in both periods (p<0.001).
80% Both groups have become more likely to be in a
seroconcordant relationship, and the gap has narrowed
slightly.
60%
43% HIV-positive
40%
40% HIV-negative
27%
22%
20%
0%
2000-2001 20008-2009

10. Unprotected anal intercourse with casual partners
100% HIV-positive are more likely to report UAIC in both periods
(p<0.001).
80% HIV-positive men have become much more likely to report
UAIC, compared with HIV-negative men (the gap has widened).
60%
HIV-positive
45%
HIV-negative
40% 38%
20%
20% 18%
0%
2000-2001 2008-2009

11. Any HIV disclosure to casual partners
100% Although HIV disclosure has become more common in both
groups, the gap has widened over time.
80%
60% 55%
48%
HIV-positive
40% HIV-negative
32%
25%
20%
0%
2000-2001 20008-2009

12. Summary
• Gay men in the GCPS have become:
– More likely to attend university
– Less likely to exclusively spend time with gay men or
have gay friends
– Less likely to have 10+ male sex partners
– More likely to be in a seroconcordant relationship
– More likely to engage in UAIC
– More likely to disclose HIV status to casual partners

13. Summary
• HIV-positive men have become more similar to HIV-
negative men in:
– Paid employment (increasing)
– No. of male partners (declining)
– Being in a seroconcordant relationship (increasing)
• The two groups have diverged in:
– Age
– University education
– Social engagement with gay men
– Unprotected anal intercourse with casual partners
– HIV disclosure

14. Conclusions
• Workforce participation and educational attainment
have improved among HIV-positive gay men, but
they still lag behind their HIV-negative peers.
• Support services will need to address issues of
HIV, sexuality and ageing among HIV-positive men.
• HIV-negative men appear to be a diversifying group
and may become more difficult to engage.
• Promoting effective relationship negotiation, HIV
disclosure and risk reduction strategies with all gay
men appears warranted.

15. Acknowledgments/further information
• Thanks to: the participants, the recruiters, AIDS
Councils, state/territory health departments.
• Paper co-authors:
Holt, M., Lee, E., Prestage, G. P., Zablotska, I., De Wit, J., &
Mao, L. (in press). The converging and diverging characteristics
of HIV-positive and HIV-negative gay men in the Australian Gay
Community Periodic Surveys, 2000-2009. AIDS Care.
• For a copy, please email m.holt@unsw.edu.au