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'Let's be honest: it's a party drug', declared the president of the AIDS Healthcare Foundation of Los Angeles, following the approval of Truvada for HIV pre-exposure prophylaxis (PrEP). Drawing on the accounts of gay and queer-identifying men, we explore the ways in which PrEP has not only made chemsex possible for a new group of people, but has also changed what chemsex is. If the association with HIV infection has helped render chemsex an object of sexual health concern, PrEP can be understood to interfere with the very ontology of chemsex, and the human and more-than-human bodies imbricated in it. This rethinking invites us to consider antiretrovirals as part of the infrastructure, or event network, of chemsex, in turn producing new kinds of embodied sexual subjects. In doing so, we argue for a more expansive account of chemsex that troubles the binaries of licit and illicit drugs, therapeutic and recreational use, and normal/deviant bodies.

This chapter reviews the risk factors and treatment options for sexuality and gender diverse populations. Sexuality is a person's sense of themselves as a sexual person and usually reflects their sexual attraction and sexual practice. Heterosexual people are sexually attracted to people of the opposite gender, lesbian women are sexually attracted to other women, gay men are sexually attracted to other men, bisexual people are sexually attracted to people of any gender, and queer people are sexually attracted to people of all genders (queer is also an umbrella term for sexuality and gender diverse people). Evidence from three nationally representative surveys suggests 3.2% of Australian adults report a non-heterosexual identity . Gender identity means the sense a person has of having a particular gender. Cisgender people identify with the sex they were assigned at birth, transgender people's gender does not align with the sex they were assigned at birth. Most transgender people identify as either woman/ female or man/male, however people who feel their gender does not align with either female or male, or exclusively with male or female, use the terms non-binary or gender fluid. There is no reliable evidence on the proportion of gender diverse people in Australia; a systematic review of US population-based surveys provided a population estimate of 0.5%. Establishing an evidence base for patterns of alcohol use and treatment outcomes among sexuality and gender diverse people is challenging. Sexuality and/or gender identity are rarely captured in large surveys and treatment studies, and markers are not included in the Alcohol and Other Drug Treatment Services National Minimum Data Set for all government funded alcohol and other drug treatment specialist services.

ObjectiveTo extend knowledge about how lesbian, gay, bisexual, trans+, and queer (LGBTQ+) people relate to their families of origin by paying particular attention to their experiences of belonging within this context.BackgroundAlthough the impact of family rejection on young LGBTQ+ people is well established, circumstances and expressions of family belonging are less well understood.MethodTaking a qualitative, social generational approach, we asked two groups of Australians, born in the 1970s (n = 14) and 1990s (n = 18), about their experiences of family relationships when they were growing up sexually and/or gender diverse.ResultsA subset of participants described feeling accepted by families of origin, although very few were gender diverse. The 1970s cohort described these experiences as culturally exceptional, and the 1990s cohort as a birthright. Examples from both demonstrate how family belonging can remain conditional.ConclusionExperiences of family belonging reveal both the importance of family to the well‐being and flourishing of LGBTQ+ people, and the entanglement between individual and social understandings of what family acceptance comprises.ImplicationsScholars and support service providers may benefit from recognizing that some sexual minorities experience belonging in their families of origin, but work remains in understanding and challenging the conditions that some families continue to impose.

IntroductionGay and bisexual men (GBM) with undiagnosed HIV are believed to contribute disproportionately to HIV transmission in Australia but national prevalence estimates have been lacking.MethodsFrom November 2013 to November 2014, we recruited men at gay venues and events in six Australian states and territories. Of 7291 survey participants, 3071 men also provided an oral fluid sample for testing and decided whether to receive their test results or not. We calculated raw and population‐weighted prevalence estimates and identified associations with undiagnosed infection using logistic regression.ResultsOf 3071 participants, 213 men tested HIV‐positive (6.9%, 95% confidence interval [CI] 6.0 to 7.8%), of whom 19 (8.9%, 95% CI 5.8 to 13.5%) were previously undiagnosed. After weighting for the size of the gay and bisexual male population in each state or territory, national HIV prevalence was estimated to be 7.2% (95% CI 6.3 to 8.1), of which 9.1% (95% CI 6.0 to 13.6%) were estimated to be undiagnosed. Compared with HIV‐negative participants, men with undiagnosed HIV were more likely to report meeting partners at sex venues, using antiretroviral drugs as pre‐exposure prophylaxis, condomless anal intercourse with casual partners, using party drugs for sex, injecting drugs and using amyl nitrite, crystal methamphetamine or gamma hydroxybutyrate in the six months prior to the survey.DiscussionThe results indicate that the prevalence of undiagnosed HIV is relatively low among Australian GBM but is higher among men who report riskier sex and drug practices.ConclusionsThe results underline the importance of targeted HIV prevention and frequent testing for men at increased risk of infection.

AbstractIntroductionWe determined the contribution of undiagnosed HIV to new infections among gay and bisexual men (GBM) over a 12‐year period in Australia where there has been increasing focus on improving testing and HIV treatment coverage.MethodsWe generated annual estimates for each step of the HIV cascade and the number of new HIV infections for GBM in Australia over 2004 to 2015 using relevant national data. Using Bayesian melding we then fitted a quantitative model to the cascade and incidence estimates to infer relative transmission coefficients associated with being undiagnosed, diagnosed and not on ART, on ART with unsuppressed virus, or on ART with suppressed virus.ResultsBetween 2004 and 2015, we estimated the percentage of GBM with HIV in Australia who were unaware of their status to have decreased from 14.5% to 7.5%. During the same period, there was a substantial increase in the number and proportion of GBM living with HIV on treatment and with suppressed virus, with the number of virally suppressed GBM increasing from around 3900 (30.2% of all GBM living with HIV) in 2004 to around 14,000 (73.7% of all GBM living with HIV) in 2015. Despite the increase in viral suppression, the annual number of new infections rose from around 660 to around 760 over this period. Our results have a wide range due to the uncertainty in the cascade estimates and transmission coefficients. Nevertheless, undiagnosed GBM increasingly appear to contribute to new infections. The proportion of new infections attributable to undiagnosed GBM almost doubled from 33% in 2004 to 59% in 2015. Only a small proportion (<7%) originated from GBM with suppressed virus.DiscussionOur study suggests that an increase in HIV treatment coverage in Australia has reduced the overall risk of HIV transmission from people living with HIV. However, the proportion of infections and the rate of transmission from undiagnosed GBM has increased substantially. These findings highlight the importance of HIV testing and intensified prevention for Australian GBM at high risk of HIV.