title: Younger age, recent HIV diagnosis, no welfare support and no annual sexually transmissible infection screening are associated with nonuse of antiretroviral therapy among HIV-positive gay men in Australia.
abstract: OBJECTIVE
  With the increasing momentum to maximize the benefits of antiretroviral therapy (ART), better understanding of opportunities and challenges in increasing ART coverage and promoting early ART initiation is urgently needed. Key sociodemographic, clinical and behavioural factors associated with Australian HIV-positive gay men's current nonuse of ART were systematically examined.
  
  
  METHODS
  Data were based on 1911 responses from HIV-positive men who had participated in the Australian Gay Community Periodic Surveys (GCPS) between 2010 and 2012. Stratified univariate analysis and multivariate logistic regression were used.
  
  
  RESULTS
  A majority of the participants were recruited from gay community venues and events and self-identified as gay or homosexual. On average, they were 44 years old and had been living with HIV for at least 10 years. Close to 80% (n=1555) were taking ART, with >90% further reporting an undetectable viral load at the time of the survey. From 2010 to 2012, there had been a moderate increase in ART uptake [adjusted odds ratio (AOR) 1.40; 95% confidence interval (CI) 1.20-1.65]. In addition, younger age (AOR 1.66; 95% CI 1.45-1.92), recent HIV diagnosis (AOR 1.78; 95% CI 1.59-1.98), not receiving any social welfare payments (AOR 2.20; 95% CI 1.05-2.54) and no annual screening for sexually transmissible infections (AOR 1.55; 95% CI 1.03-2.34) were independently associated with ART nonuse.
  
  
  CONCLUSIONS
  Current ART coverage among HIV-positive gay men in Australia is reasonably high. To further increase ART coverage and promote early ART initiation in this population, better clinical care and sustained structural support are needed for HIV management throughout their life course.
authors.affiliation: Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Mao
authors.forename: J B
authors.initials: JB
authors.lastname: de Wit
authors.forename: S C
authors.initials: SC
authors.lastname: Kippax
authors.forename: G
authors.initials: G
authors.lastname: Prestage
authors.forename: M
authors.initials: M
authors.lastname: Holt
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D044362:Australasia / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology*; D015438:Health Behavior; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology; D008875:Middle Aged; D011159:Population Surveillance; D012946:Social Welfare; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: antiretroviral therapy; behavioural surveillance; early treatment initiation; gay men; treatment coverage