Publications by authors named "John Rule"

Background: In the last decade, while HIV diagnoses have declined among Australian-born gay and bisexual men (GBM), they have declined much less among migrant GBM, with recently arrived GBM facing particular challenges, such as access to HIV treatment. This study assessed HIV care cascade (treatment) outcomes among GBM living with HIV in Australia by migration status.

Methods: Data were collected in national cross-sectional behavioural surveillance surveys during 2019-2022.

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Peer support from social networks of gay, bisexual, and other men who have sex with men (GBMSM) has been recognised as a critical driver of engagement with HIV prevention. Using data from an online cross-sectional survey of 1,032 GBMSM aged 18 or over in Australia, a latent class analysis was conducted to categorise participants based on social support, LGBTQ + community involvement, and social engagement with gay men and LGBTQ + people. Comparisons between classes were assessed using multivariable multinomial logistic regression.

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Background People living with HIV (PLHIV) have historically faced a range of challenges negotiating satisfying sex lives in the context of virus transmission risks and HIV-related stigma. We examine the experience of sexual satisfaction among PLHIV in an era of pre-exposure prophylaxis (PrEP) and undetectable=untransmissible (U=U)/treatment as prevention. Methods Data are derived from HIV Futures 9, a cross-sectional survey of PLHIV in Australia conducted between December 2018 and May 2019.

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Prevalence and incidence of HIV among people aged 50 years and older continue to rise worldwide, generating increasing awareness among care providers, scientists, and the HIV community about the importance of brain health in older adults with HIV. Many age-related factors that adversely affect brain health can occur earlier and more often among people with HIV, including epigenetic ageing, chronic medical conditions (eg, cardiovascular disease), and age-related syndromes (eg, frailty). Extensive dialogue between HIV community leaders, health-care providers, and scientists has led to the development of a multidimensional response strategy to protect and enhance brain health in people ageing with HIV that spans across public health, clinical spaces, and research spaces.

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The emergence of the COVID-19 pandemic required an immediate global clinical research response. The ACTIV (Accelerating COVID-19 Therapeutic Interventions and Vaccines)-3 trials and the ACTIV-associated Outpatient Treatment with Anti-Coronavirus Immunoglobulin trial used Good Participatory Practices (GPP) to develop materials for study implementation from a global network perspective. GPP guidelines offer a framework for engaging stakeholders throughout the research process.

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Introduction: HIV pre-exposure prophylaxis (PrEP) has been publicly available since 2018 in Australia as a daily regimen. In 2019, clinical guidelines were updated to support guidance on event-driven PrEP (ED-PrEP) use. We assessed trends in the PrEP dosing regimen by comparing daily PrEP use to ED-PrEP among cisgender gay, bisexual and other men who have sex with men (GBMSM).

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HIV community peer navigators and treatment officers are important sources of information and guidance for people living with HIV. We conducted an anonymous online survey with members of the treatment outreach network of the Australian National Association of People Living with HIV. The survey explored understandings and acceptance of HIV cure research and was disseminated before and following an interactive workshop on HIV cure.

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Article Synopsis
  • * It found a significant decrease in "frequent comprehensive testing" among HIV-negative GBM using PrEP, dropping from 71.7% in 2017 to 58.6% in 2021, with similar declines in non-PrEP users and HIV-positive participants.
  • * The research suggests many GBM are not adhering to Australian STI testing guidelines of quarterly testing, prompting a call for further evaluation of the guidelines' relevance and necessity.
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Using repeated behavioural surveillance data collected from gay and bisexual men (GBM) across Australia, we assessed trends in HIV prevention coverage (the level of 'safe sex' achieved in the population by the use of effective prevention methods, including condoms, pre-exposure prophylaxis [PrEP] and having an undetectable viral load). We stratified these trends by age, country of birth/recency of arrival, sexual identity, and the proportion of gay residents in the participant's suburb. Among 25,865 participants with casual male partners, HIV prevention coverage increased from 69.

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Purpose: To better understand what is most important to people living with human immunodeficiency virus (PLWH) when choosing their treatment. We assessed how PLWH trade off the potential risks and benefits of oral and long acting injectable (LAI) treatments.

Participants And Methods: Firstly, in-depth interviews were conducted with 11 PLWH to develop a holistic understanding of experiences and determine attributes that contribute to treatment decision-making.

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Article Synopsis
  • In 2018, concerns about privacy and data security arose regarding Australia's 'My Health Record' system, particularly from consumer advocates for marginalized groups, leading to a study on these issues.
  • The study involved 16 interviews with representatives from stigmatised communities, highlighting skepticism towards the benefits of electronic health records and the need for better privacy protections.
  • To trust digital health systems, reforms are crucial, emphasizing data justice through continued consultation with affected communities regarding their health data management.
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COVID-19 has disrupted sexual behaviour and access to health systems. We adapted regular HIV behavioural surveillance of gay and bisexual men (GBM) in Australia in response to COVID-19, assessed the impact on the profile of the sample, the participants' HIV-related behaviour, and whether COVID-19 may have accentuated existing disparities in the Australian HIV epidemic. Data collected from five states during July 2017-June 2021 were included (N = 31,460).

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This paper examines how antiretroviral therapy (ART) use and fears towards the onward transmission of HIV have changed among people living with HIV (PLHIV) in Australia between 1997 and 2018. Participants were recruited as part of the HIV Futures study, a large cross-sectional survey of PLHIV in Australia, in 1997, 2003, 2012 and 2018 (total n = 3889). ART use, viral load detectability, and fear of onward HIV transmission were compared between years.

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Introduction: Structural stigma in the global HIV response is a "moving target" that constantly evolves as the epidemic changes. Tackling structural stigma requires an understanding of the drivers and facilitators of stigma in complex community, policy and health systems. In this paper, we present findings from a study adopting a systems perspective to understand how to tackle structural stigma via the Meaningful Involvement of People with HIV/AIDS (MIPA), while highlighting the challenges in demonstrating peer leadership from people living with HIV (PLHIV).

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Effective HIV treatments have transformed the medical needs of people living with HIV (PLHIV) to a chronic condition. However, stigma, poorer mental health outcomes and social isolation remain significant challenges for many PLHIV. HIV peer support programs have assisted PLHIV in navigating the clinical, emotional and social aspects of living with HIV.

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Article Synopsis
  • Changes in social connections among gay, bisexual, and other men who have sex with men (GBM) in Australia have important effects on HIV prevention strategies.
  • Data from surveys conducted between 1998 and 2020 show a decline in gay social engagement (GSE), particularly among younger GBM, which could impact their HIV-related health outcomes.
  • Higher GSE is linked to positive factors like older age and education, but also some risky behaviors, highlighting the need for tailored health promotion strategies for GBM with lower social connections.
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Background: In 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP) healthcare expenditure, improve ART adherence, and better maintain HIV suppression.

Methods: Using data from a national, 2-year prospective study of adults with HIV on ART (n=364) (2013-2017), we compared OOP healthcare expenditure, ART adherence, and virological failure (VF) in participants subject to the co-payment policy change with participants from other jurisdictions who never paid, and who always paid, co-payments.

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Social research with people living with HIV (PLHIV) rarely distinguishes between gay men and bisexual men. However, bisexual men may have unique experiences of HIV-related stigma and distinct support needs. In this paper, findings are presented from a cross-sectional survey of Australian PLHIV, which included the Berger (HIV) stigma scale.

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Objectives: To assess trends in HIV prevention strategies among Australian gay and bisexual men (GBM) since the introduction of preexposure prophylaxis (PrEP), the level of net prevention coverage (the use of safe strategies), and the characteristics of HIV-negative and untested GBM who remain at risk of HIV.

Design: Repeated behavioural surveillance of GBM recruited from venues, events and online in seven Australian states and territories.

Methods: Participants with casual male partners were included.

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Wearing masks is a CDC-recommended* approach to reduce the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), by reducing the spread of respiratory droplets into the air when a person coughs, sneezes, or talks and by reducing the inhalation of these droplets by the wearer. On July 2, 2020, the governor of Kansas issued an executive order (state mandate), effective July 3, requiring masks or other face coverings in public spaces. CDC and the Kansas Department of Health and Environment analyzed trends in county-level COVID-19 incidence before (June 1-July 2) and after (July 3-August 23) the governor's executive order among counties that ultimately had a mask mandate in place and those that did not.

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Unlabelled: Background A substantial minority of patients living with HIV refuse or cease antiretroviral therapy (ART), have virological failure (VF) or develop an AIDS-defining condition (ADC) or serious non-AIDS event (SNAE). It is not understood which socioeconomic and psychosocial factors may be associated with these poor outcomes.

Methods: Thirty-nine patients with poor HIV treatment outcomes, defined as those who refused or ceased ART, had VF or were hospitalised with an ADC or SNAE (cases), were compared with 120 controls on suppressive ART.

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Objectives: We quantified concomitant medication polypharmacy, pharmacokinetic and pharmacodynamic interactions, adverse effects and adherence in Australian adults on effective antiretroviral therapy.

Design: Cross-sectional.

Methods: Patients recruited into a nationwide cohort and assessed for prevalence and type of concomitant medication (including polypharmacy, defined as ≥5 concomitant medications), pharmacokinetic or pharmacodynamic interactions, potential concomitant medication adverse effects and concomitant medication adherence.

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Introduction: This paper reports changes in behavioral outcomes related to the use of HIV testing service of a project that employed peer-based education strategies and integration of HIV voluntary counseling and testing (VCT) and Sexual and Reproductive Health (SRH) services targeting young people aged 15-24 across 5 provinces in Vietnam.

Methods: A pre-test/post-test, non-experimental evaluation design was used. Data were collected from cross-sectional surveys of youth and client exit interviews at project supported SRH clinics conducted at baseline and again at 24 months following implementation.

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Since the publication of the World Health Report 2008, there has been renewed interest in the potential of primary health care (PHC) to deliver global health policy agendas. The WHO Western Pacific Regional Strategy 2010 states that health systems in low- and middle-income countries (LMICs) can be strengthened using PHC values as core principles. This review article explores the development of an evidence-based approach for assessing the effectiveness of PHC programs and interventions in LMICs.

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