Nathan Lachowsky, PhD CandidateYoung Gay Men’s PanelBC Gay Men’s Health Summit4 November 2011

Include map Auckland: 1.42 million people (2010)

Background: New Zealand’s HIV Epidemic

Younger Gay Men & HIV Objectives Methods: HIV sociobehavioural surveillance Results: Younger Gay Men vs Older Gay Men

Conclusions Future Research & Next Steps Questions & Dialogue

Gay men continue to be disproportionately and predominantly affected by HIV in New Zealand

71.4% of new HIV diagnoses in 2010

2010 was 2nd highest number of new diagnoses in New Zealand’s history

Characteristics of MSM Diagnosed with HIV in New Zealand, 2010 (n=90)

%

EthnicityNZ European/PakehaMaoriAsianPacific

711010

1

Infected in New Zealand 71

Late Diagnosis 48

Age 15-29 at Diagnosis 32

Unique New Zealand context and experience of younger gay men (YGM) Increased rights: Homosexual Law Reform 1986,

Human Rights Acts 1993, Civil Unions 2005

Availability of effective HIV treatments: HAART 1997

Improved prognosis for HIV-positive individuals

Connectedness to “gay community”: less or different? International interest in YGM New generation; “post-AIDS” era

Recent increase in HIV infection rates within USA

Compare HIV-related knowledge, attitudes, and behaviours between:

Younger gay men (YGM) & older gay men (OGM)

▪ YMSM: 16 – 29 years of age

▪ OMSM: 30+ years of age

Focus on and strategy of primary prevention

Pooled sample of 3387 YGM and 5602 OGM from the 2006, 2008, and 2011 rounds of New Zealand’s sociobehavioural HIV surveillance

Gay Auckland Periodic Sex Survey (GAPSS) and

Gay men’s Online Sex Survey (GOSS)

Anonymous and self-completed questionnaires Reproducible convenience sample Second-generation surveillance: “gold standard”

World Health Organization recommended

Offline recruitment (1 week in February) Big Gay Out: 29.4% of pooled sample

Gay bars: 4.7% of sample

Sex-on-site venues : 7.7% of sample Online recruitment (2-4 weeks following) Internet dating sites: 58.2% of sample

Statistical analyses controlled for survey year Mantel-Haenszel chi-square and multinomial

logistic regression

* = Statistically significant difference (p<0.05)

RESULTS

Table 1. Demographic and testing comparisons

YGM (%)

OGM (%)

Demographics

Recruited: online 67.4 52.9

Ethnicity: NZ European/Pakeha 68.5 80.6

Identity: bisexual 24.0 21.5

Testing (in previous 12 months)

Tested for HIV (excluding known-positives) 39.9 39.5

Tested HIV positive (at last HIV test) 0.9 4.7

Sexual health testing/treatment 47.0 45.4

Any STI (not including HIV) 9.0 9.0

*

*

*

*

* Statistically significant difference between younger and older MSM, p<0.05

Data only from 2006 & 2008

Data from 2006.2008, & 2011

*

*

* *

* p<0.05

0%

20%

40%

60%

80%

100%

“Anal sex without a condom is very high

risk”

“Oral sex is low risk” “HIV is more easily transmitted in early

stages”

“HIV cannot pass through an

undamaged condom”

% o

f g

ay

me

n w

ho

kn

ew

st

ate

me

nt

wa

s fa

ctFigure 1. HIV-Related Knowledge in Younger and Older Gay Men in New Zealand, 2006, 2008, & 2011 combined

Younger GM Older GM

Data from 2006.2008, & 2011

Data from 2006.2008, & 2011

Data from 2006.2008, & 2011

Data from 2006.2008, & 2011

0%

20%

40%

60%

80%

100%

HIV is a less serious threat that it used to be because of

new treatments

Condoms are OK as part of

sex

I’d rather risk HIV that use a

condom during anal sex

I don’t like condoms

because they reduce

sensitivity

A man who knew he has

HIV would tell me before sex

% o

f g

ay

me

n w

ho

ag

ree

dw

ith

th

e s

tate

me

nt

Figure 2. HIV-Related Attitudes in Younger and Older Gay Men in New Zealand, 2006, 2008, & 2011 combined

Younger GM Older GM * p<0.05

* *

Table 2. Sexual behaviour and condom use comparisons

YGM (%)

OGM (%)

Sexual Behaviour ( in previous 6 months)

Number of sex partners: NoneNumber of sex partners: >5

9.829.1

6.839.6

Any casual partnerIf casual partner, % having anal sex

71.980.7

75.377.4

Current regular partnerLength of relationship <6 monthsIf regular partner, % having anal sex

42.741.289.2

50.418.782.3

>1 regular partner and casual partner(s) 30.6 32.5

Condom Use

High condom use with boyfriend 37.2 31.9

High condom use with fuckbuddy 58.9 61.3

High condom use with casual partner 73.6 77.0

*

**

****

*

*

0%

5%

10%

15%

20%

25%

30%

35%

No sex with a man

1 regular partner only

>1 regular partners, no

casual

1 regular partner and

casual

>1 regular partners and

casual

Casual sex only

% o

f g

ay

me

n r

ep

ort

ing

Sexual/Relational Partnering Combinations (<6 months)

Figure 5. Sexual/Relational Partnering in Last 6 Months of Younger Gay Men in New Zealand

Younger GM Older GM * p<0.05

*

*

YGM and OGM similarities and differences:

YGM less knowledge, fewer partners, less casual sex, more anal sex, and more condom use with boyfriends, but less with casual partners

Need for strategic, targeted HIV/sexual health promotion for YGM and other YMSM

Contributes to evidence-based health promotion and prevention efforts

Strengths: Novel research on YGM in New Zealand

Gold standard HIV sociobehavioural surveillance

Survey data collected both online and offline

Large pooled sample allowing sub-analyses Limitations: Debate regarding “younger” definition/classification

Impact of online venue (not online sexual activity)

Univariate analyses presented, multivariate analyses can take into account other confounders

Disseminate this research on YGM Present to affected and interested groups

Post findings to community: blogs, news stories

Publish results: conferences and journal articles Continue with research plan Multivariate analyses on condom use and HIV

testing

Cross-ethnic analysis Advocacy and pressure for greater funding to

continue and expand research efforts

Expanded research into other communities

Different geographic areas in New Zealand

Other populations at risk of HIV infection

Further investigation into differences between HIV-related risks for YGM

Sexual activity with partners met online vs offline

Use qualitative research to help understand and explore sexual networks and concurrency

Investigate resiliency and protective factors

University of Otago PJW Saxton

NP Dickson

New Zealand AIDS Foundation AJ Hughes

University of Guelph CE Dewey

AJS Summerlee

Nathan Lachowskynlachows@uoguelph.ca