Nathan Lachowsky, "Comparing younger and older gay men & other MSM in New Zealand"
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Transcript of Nathan Lachowsky, "Comparing younger and older gay men & other MSM in New Zealand"
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Nathan Lachowsky, PhD CandidateYoung Gay Men’s PanelBC Gay Men’s Health Summit4 November 2011
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Include map Auckland: 1.42 million people (2010)
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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
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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
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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
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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
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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
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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)
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RESULTS
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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
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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
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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
* *
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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
*
**
****
*
*
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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
*
*
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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
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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
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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
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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
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University of Otago PJW Saxton
NP Dickson
New Zealand AIDS Foundation AJ Hughes
University of Guelph CE Dewey
AJS Summerlee
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Nathan [email protected]