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The Flux Study

The challenge

Changes in sexual behaviour, health-seeking, and social connectedness among gay and bisexual men (GBM) due to things such as drug use, HIV pre-exposure prophylaxis (PrEP), COVID-19, and now Monkeypox (mpox) can impact on trends in HIV and STIs. It is important to be able to monitor these changes as infections emerge that impact the lives of GBM, such as COVID-19 and mpox, and new ways of preventing HIV and STIs become available, to understand the contexts and reasons for fluctuations in HIV and STI trends that may result from changes in response to these factors.

The project

Leveraging on a longstanding and established cohort study of 3,200 gay and bisexual men since 2014, this project is uniquely placed to monitor trends in sexual and other risk behaviours among GBM as PrEP was introduced in Australia, throughout the COVID-19 pandemic, and now with the transmission of mpox among sexual networks of these men. No other longitudinal research project is positioned to be able to collect these data. Findings will directly inform interpretations of epidemiological trends in HIV and STIs.

The method

The established study infrastructure facilitates an open cohort design, with automated follow-up. Ongoing enrolment occurs throughout the study period. Weekly online questionnaires ('Weekly diaries') were used to detect and report short-term data trends in sexual and other risk behaviours between May 2020 – May2021. Six-monthly follow-up has continued as the minimum since 2014. Online questionnaires are currently being distributed to participants on a quarterly basis (every three months).

In-depth, semi-structured interviews have also been used to investigate more deeply the impacts of COVID-19.

The results
  • Development of a reliable measure of drug sensation-seeking among GBM (2017)
  • Although GBM who used crystal were more likely to have engaged in condomless anal intercourse with casual partners, they were also more likely to use biomedical HIV prevention to mitigate against the risks of HIV infection (2019)
  • Among PrEP-eligible men, we found that PrEP use was independently associated with lower levels of HIV anxiety (2020)
  • GBM in Australia dramatically reduced their sexual contacts with other men in response to COVID-19 (2020)
  • GBM developed strategies in the COVID-19 pandemic to minimise the risk of exposure in sexual contexts (2021)
The impact

HIV and STI epidemiological trends will be impacted by behaviour change to things such as changes in drug use, adoption of PrEP, the COVID-19 pandemic, and the transmission of mpox. Findings from this study will uniquely provide explanations and contexts for understanding those trends and will inform ongoing health and community interventions targeting GBM.

Project collaborators

Centre for Social Research in Health, UNSW Sydney; Australian Research Centre in Sex Health and Society, Latrobe University; Faculty of Medical and Health Sciences, Social and Community Health, University of Auckland; National Drug and Alcohol Research Centre, UNSW Sydney; Australian Federation of AIDS Organisations (AFAO); LGBTIQ+ Health Australia; ACON; Thorne Harbour Health.