BACKGROUND: Gay and bisexual men (GBM) in Australia increasingly use biomedical prevention methods. Rising ‘net prevention coverage’ (the use of any effective strategy e.g. condoms, PrEP or undetectable viral load, UVL) is associated with declining HIV infections. However, disparities in prevention coverage are believed to exist. We analysed variations in prevention coverage to identify opportunities for intervention.
METHODS: Behavioural surveillance data were collected during 2017-21 from gay venues, events and online in seven states/territories. Trends in net prevention coverage and HIV risk (condomless anal sex with casual partners unprotected by PrEP or UVL) were assessed with logistic regression, stratifying by age, country of birth, sexual orientation and the proportion of gay residents in participants’ residential suburbs.
RESULTS: 25,865 survey responses from participants with casual male partners were included. The mean age was 37.6 years, 69.8% were Australian-born, 88.2% gay-identified, and 9.7% living with HIV. Net prevention coverage increased from 69.8% in 2017 to 75.1% in 2021 (p<.001), and HIV risk declined from 30.2% to 24.9% (p<.001), influenced by rising PrEP use (15.6% to 33.9%, p<.001). Participants aged <25 years were the most likely to consistently use condoms (33.5% in 2017 to 25.4% in 2021, p=.02), but also reported the highest levels of HIV risk (42.2% in 2017 to 40.8% in 2021, p=.01). 25-44 year olds were the most likely to use PrEP (18.7% to 39.0%, p<.001) and 45 year olds the most likely to use/report UVL (13.6% to 11.8%, p=.02). In 2021, net prevention coverage was lower among Australian-born vs. overseas-born men (73.5% vs. 78.9%, p<.001), and higher among gay vs. bisexual/other-identified participants (77.7% vs. 63.4%, p<.001). During 2017-21, net prevention coverage increased more in suburbs with 10% gay residents (73.4% to 88.3%, p<.001) and less in suburbs with <10% gay residents (68.9% to 73.7%, p<.001).
CONCLUSIONS: Recent increases in HIV prevention coverage are concentrated among older GBM and suburbs with more gay residents. Younger men and bisexual men remain more at risk of HIV, more reliant on condoms, and less likely to use PrEP or UVL. Encouraging greater prevention coverage in these groups is necessary to further reduce HIV risk in Australia.

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