To obtain more complete mortality data following HIV and AIDS diagnosis in Australia, HIV/AIDS diagnoses between 1980 and 2003 were linked to the National Death Index. Based on 6900 known deaths, and 1455 known non-deaths, sensitivity and specificity of the linkage was estimated to be 82% and 92% respectively. Mortality rates were compared by calendar period, pre-ART (<1990), pre- and early-HAART (1990-1996) and late-HAART (1997-2003). Mortality following AIDS decreased from 590.2/1000 person years pre-ART to 77.4 during the late-HAART period. Mortality following HIV diagnosis prior to AIDS increased from 9.7 to 20.2/1000 person years. The total number living with diagnosed HIV infection in Australia was estimated to have increased from 7873 at the end of 1989 to 12828 in 2003. Risk factors for survival following HIV and AIDS diagnosis were assessed using Cox regression. Age >40 years and certain HIV exposure results were associated with poorer survival following HIV. Predictors of poorer survival following AIDS were age >40 years, females exposed to HIV through receipt of blood, CD4 count <20 and certain AIDS illnesses. Parametric models of survival following HIV and AIDS diagnosis were assessed using likelihood based criteria. Goodness of fit was assessed by comparing observed with model predicted numbers of deaths. Weibull models were found to fit best to both survival following HIV and AIDS. Parametric survival models were used to project deaths after HIV and AIDS across three scenarios of HAART usage. Deaths following HIV were projected to remain low, but to increase from 223 in 2005 to 288, 292 and 282 in 2010 if the HAART usage remains stable at 2005 levels, increases to 70% of all people with diagnosed HIV by 2010 and decreases to 39% of all people with diagnosed HIV respectively. Deaths after AIDS diagnosis were projected to increase unless if HAART usage increases to 100% of AIDS diagnoses by 2010.

To obtain more complete mortality data following HIV and AIDS diagnosis in Australia, HIV/AIDS diagnoses between 1980 and 2003 were linked to the National Death Index. Based on 6900 known deaths, and 1455 known non-deaths, sensitivity and specificity of the linkage was estimated to be 82% and 92% respectively. Mortality rates were compared by calendar period, pre-ART (<1990), pre- and early-HAART (1990-1996) and late-HAART (1997-2003). Mortality following AIDS decreased from 590.2/1000 person years pre-ART to 77.4 during the late-HAART period. Mortality following HIV diagnosis prior to AIDS increased from 9.7 to 20.2/1000 person years. The total number living with diagnosed HIV infection in Australia was estimated to have increased from 7873 at the end of 1989 to 12828 in 2003. Risk factors for survival following HIV and AIDS diagnosis were assessed using Cox regression. Age >40 years and certain HIV exposure results were associated with poorer survival following HIV. Predictors of poorer survival following AIDS were age >40 years, females exposed to HIV through receipt of blood, CD4 count <20 and certain AIDS illnesses. Parametric models of survival following HIV and AIDS diagnosis were assessed using likelihood based criteria. Goodness of fit was assessed by comparing observed with model predicted numbers of deaths. Weibull models were found to fit best to both survival following HIV and AIDS. Parametric survival models were used to project deaths after HIV and AIDS across three scenarios of HAART usage. Deaths following HIV were projected to remain low, but to increase from 223 in 2005 to 288, 292 and 282 in 2010 if the HAART usage remains stable at 2005 levels, increases to 70% of all people with diagnosed HIV by 2010 and decreases to 39% of all people with diagnosed HIV respectively. Deaths after AIDS diagnosis were projected to increase unless if HAART usage increases to 100% of AIDS diagnoses by 2010.

The Australian HIV Observational Database (AHOD) is a collaboration of hospitals, sexual health clinics and specialist general practices throughout Australia, established in April 1999. Core data variables collected include demographic data, immunological and virological markers, AIDS diagnosis, antiretroviral and prophylactic treatment and cause of death. The first electronic data transfer occurred in September 1999 followed by six monthly data transfers thereafter. All analyses included in this thesis are based on patients recruited to AHOD by March 2004. By March 2004, 2329 patients had been recruited to AHOD from 27 sites throughout Australia. Of these, 352 (15%) patients were recruited from non-metropolitan clinics. The majority of patients were male (94%), and infected with HIV through male homosexual contact (73%). Almost 90% of AHOD patients are antiretroviral treatment experience, and the majority of patients are receiving triple therapy as mandated by standard of care guidelines in Australia. Antiretroviral treatment use has changed in Australia reflecting changes in the availability of new treatment strategies and agents. The crude mortality rate was 1.58 per 100 person years, and of the 105 deaths, more than half died from HIV-unrelated deaths. The prevalence of HBV and HCV in AHOD was 4.8% and 10.9%, respectively. HIV disease progression in the era of highly active antiretroviral treatment (HAART) among AHOD patients is consistent with what has been reported in developed countries. Common factors associated with HIV disease progression were low CD4 cell count, high viral load and prior treatment with mono or double therapy at the time of commencing HAART. This was demonstrated in AHOD in terms of long-term CD4 cell response, the rate of changing combination antiretroviral therapy and factors predicting death. HBV and HCV coinfection is also relatively common in AHOD, similar to other developed country cohorts. Coinfection does not appear to be serious impediments to the treatment of HIV infected patients. However, HIV disease outcome following HAART does appear to be adversely affected by HIV/HCV coinfection but not in terms of HIV/HBV coinfection. Patients attending non-metropolitan sites were found to be similar to those attending metropolitan sites in terms of both immunological response and survival.

This project critically examines the question Are HIV/AIDS prevention campaigns more effective at engaging gay men if they use colloquial language and sexually explicit imagery? by investigating the impact of sexually explicit campaigns on the Sydney gay community. The project approaches the question in three parts: 1. A review of literature exploring the circumstances in which and for what reasons sexually explicit HIV/AIDS campaigns are produced. 2. An analysis of seven interviews with producers of HIV prevention campaigns exploring how, why, where and for what reasons explicit campaigns are produced. 3. An analysis of eight interviews with homosexually active Sydney men exploring how HIV prevention campaigns are viewed, consumed and understood. The interviews were in-depth, semi-structured and conducted over one hour per interviewee. The findings are dominated by two interrelated and at times conflicting themes. First, that there is a strongly held belief by campaign producers that the most effective HIV prevention campaigns targeting gay men are produced by the community and reflect that community and as a result must at times be sexually explicit. Second, that it is no longer sufficient for HIV prevention campaigns to rely on explicit sex to attract attention. In an environment where visual images, and sexually explicit visual images especially, are becoming more accessible, and media and communication is more prevalent and complex, safe sex campaigns are forced to deliver ever more sophisticated and stimulating creative materials in order to maintain the engagement of gay men. The interviews revealed that both campaign producers and consumers participated in the production of a visual literacy of safe sex campaigns. This literacy was necessary to both effectively produce and comprehend the campaigns. The interviews showed that while HIV prevention campaigns that use sexually explicit language and imagery can be highly effective at engaging gay men, the success of sexually explicit campaigns is contextual that is, dependent on where, to whom and in what circumstances the materials are delivered. The audience??s accumulation of knowledge and cultural experience when viewing the campaigns, in other words their safe sex campaign literacy, significantly influenced their capacity to understand, appreciate and be engaged with sexually explicit HIV prevention campaigns.

This project critically examines the question Are HIV/AIDS prevention campaigns more effective at engaging gay men if they use colloquial language and sexually explicit imagery? by investigating the impact of sexually explicit campaigns on the Sydney gay community. The project approaches the question in three parts: 1. A review of literature exploring the circumstances in which and for what reasons sexually explicit HIV/AIDS campaigns are produced. 2. An analysis of seven interviews with producers of HIV prevention campaigns exploring how, why, where and for what reasons explicit campaigns are produced. 3. An analysis of eight interviews with homosexually active Sydney men exploring how HIV prevention campaigns are viewed, consumed and understood. The interviews were in-depth, semi-structured and conducted over one hour per interviewee. The findings are dominated by two interrelated and at times conflicting themes. First, that there is a strongly held belief by campaign producers that the most effective HIV prevention campaigns targeting gay men are produced by the community and reflect that community and as a result must at times be sexually explicit. Second, that it is no longer sufficient for HIV prevention campaigns to rely on explicit sex to attract attention. In an environment where visual images, and sexually explicit visual images especially, are becoming more accessible, and media and communication is more prevalent and complex, safe sex campaigns are forced to deliver ever more sophisticated and stimulating creative materials in order to maintain the engagement of gay men. The interviews revealed that both campaign producers and consumers participated in the production of a visual literacy of safe sex campaigns. This literacy was necessary to both effectively produce and comprehend the campaigns. The interviews showed that while HIV prevention campaigns that use sexually explicit language and imagery can be highly effective at engaging gay men, the success of sexually explicit campaigns is contextual that is, dependent on where, to whom and in what circumstances the materials are delivered. The audience??s accumulation of knowledge and cultural experience when viewing the campaigns, in other words their safe sex campaign literacy, significantly influenced their capacity to understand, appreciate and be engaged with sexually explicit HIV prevention campaigns.