Causes of the causes: Identification of the social determinants of UAI among MSM in Australia

Background: The aim of this research was to assess the relationship between the upstream social determinants of health (SDH) and risky HIV sexual behaviors among men who have sex with men (MSM). Methods: A time-location sampling method was used to survey 506 MSM (as of this abstract submission) from South East Queensland, Australia (SEQ). Potential participants were recruited in person at venues randomly selected from a universe of venue-day-time periods where MSM can be found in SEQ. The questionnaire included tested and validated tools which asked about discrimination, community and family support & other upstream SDH. Results: Of the participants, 65% reported unprotected anal intercourse (UAI) in the past six months. In bivariate analyses, community support (n=183) was related to each form of risk UAI. Due to the distribution of the UAI variable, a negative binomial regression was fit to calculate incidence rate ratios (IRR). In the analysis, an increased rate of risk UAI was found for lack of community support (IRR=1.8, 95%CI: 1.6, 2.1), and lack of family support (IRR=2.8, 95%CI: 2.2, 3.7). Conclusions: Policy makers should consider evaluating whether their needs assessment tools identify the upstream SDH and their relationship to risky HIV behaviour for their most-at-risk-populations. Identifying the social determinants during the needs assessment, will aid in knowing the specifics of the local epidemic so the targeted interventions can be adapted as the determinants of risky HIV sexual behaviour change.