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A partnership between academic, community and government experts will provide new knowledge of HIV-related behaviour for under-researched groups.

New national research targeting gay, bisexual and heterosexually identified men who have sex with men (MSM) will ensure Australia’s HIV response stays relevant to the changing HIV epidemic. The survey will examine how a range of MSM understand and manage their HIV risk and sexual health.

The survey is part of a five-year project aimed at engaging harder-to-reach MSM – overseas-born men, bisexual men and men less connected to gay networks – to improve their health outcomes. The research will provide critical new knowledge of their HIV-related behaviour and health literacy to refine HIV prevention and testing programs.

��������’s Centre for Social Research in Health (CSRH) is partnering with the Australian Federation of AIDS Organisations (AFAO), the Kirby Institute, the National Association of People with HIV Australia (NAPWHA), and state government departments of health on the NHMRC-funded project.

“Australia’s HIV epidemic is rapidly changing,” says lead investigator Professor Martin Holt from CSRH. “New technologies, particularly pre-exposure prophylaxis (PrEP) and antiretroviral drugs, have revolutionised HIV prevention.

“Australia has succeeded in driving down annual HIV diagnoses by 23% in the last five years. However, this overall fall masks a lack of progress, particularly among harder-to-reach groups. Addressing these disparities is vital if Australia wants to capitalise on its initial success with PrEP.”

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Australia is one of the few countries that has conducted regular behavioural surveillance of its primary HIV-affected population, gay and bisexual men, in line with World Health Organisation recommendations, Prof. Holt says.

The research project, Enhancing behavioural surveillance to address gaps and disparities in Australia’s HIV response in a changing HIV epidemic, builds on more than 20 years of behavioural surveillance through the annual Australian Gay Community Periodic Surveys and the Gay Asian Men’s Surveys, conducted by CSRH in collaboration with other �鶹��madou researchers, policymakers and community organisations.

“Governments and community organisations rely on this data to guide HIV policy and practice,” Prof. Holt says. “However current challenges demand new evidence and methods to ensure behavioural surveillance is fit-for-purpose.”

One of the activities in the project is a new national survey of bisexual and heterosexually-identified men who have sex with men. Representative samples of adult Australians suggest that the ratio of behaviourally bisexual men to homosexual men is 2:1, and that many identify as heterosexual.

“These men are relatively invisible and under-researched, making it difficult to design appropriate services and interventions.” The historical focus on gay men in the existing surveys, for example, may deter bisexual and heterosexual MSM from participating, he says.

The survey, which will be supplemented by in-depth interviews, will consider MSM’s sex and relationships with male, female and non-binary partners as well as their attitudes towards disclosing their sexual behaviour to partners and health service providers.

Combining survey data with in-depth interviews will help identify barriers and enablers to engaging bisexual and heterosexual MSM in HIV prevention, says chief investigator Professor Christy Newman from CSRH. Prof. Newman is leading the qualitative component of the survey.

“The interviews will help us identify participants’ preferred forms of HIV testing and prevention, as well as increasing our understanding of the ways they negotiate sex and relationships with different partners,” she says.

“Knowledge about their strategies for maintaining secrecy or decisions to disclose, and the issues this can generate for them, will help us revise state and territory prevention programs to better serve their needs.”

The research will also target MSM outside inner-city suburbs. While HIV diagnoses in gay-identified men in inner-city suburbs have dramatically decreased, diagnoses have not declined among men living in suburban locations.

“To ensure the continued recruitment of the most-at-risk men who have sex with men in the GCPS, we will trial the expansion of face-to-face and online recruitment targeting non-inner-city locations,” Prof. Holt says.