IntroductionTreatment as prevention has mobilized new opportunities in preventing HIV transmission and has led to bold new UNAIDS targets in testing, treatment coverage and transmission reduction. These will require not only an increase in investment but also a deeper understanding of the dynamics of combining behavioural, biomedical and structural HIV prevention interventions. High-income countries are making substantial investments in combination HIV prevention, but is this investment leading to a deeper understanding of how to combine interventions? The combining of interventions involves complexity, with many strategies interacting with non-linear and multiplying rather than additive effects.DiscussionDrawing on a recent scoping study of the published research evidence in HIV prevention in high-income countries, this paper argues that there is a gap between the evidence currently available and the evidence needed to guide the achieving of these bold targets. The emphasis of HIV prevention intervention research continues to look at one intervention at a time in isolation from its interactions with other interventions, the community and the socio-political context of their implementation. To understand and evaluate the role of a combination of interventions, we need to understand not only what works, but in what circumstances, what role the parts need to play in their relationship with each other, when the combination needs to adapt and identify emergent effects of any resulting synergies. There is little development of evidence-based indicators on how interventions in combination should achieve that strategic advantage and synergy. This commentary discusses the implications of this ongoing situation for future research and the required investment in partnership. We suggest that systems science approaches, which are being increasingly applied in other areas of public health, could provide an expanded vocabulary and analytic tools for understanding these complex interactions, relationships and emergent effects.ConclusionsRelying on the current linear but disconnected approaches to intervention research and evidence we will miss the potential to achieve and understand system-level synergies. Given the challenges in sustaining public health and HIV prevention investment, meeting the bold UNAIDS targets that have been set is likely to be dependent on achieving systems level synergies.

Abstract. Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM's access to and use of these technologies. At the personal level, stigma can affect individual gay men's sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM's incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma.Additional keywords: community mobilisation, health promotion, men who have sex with men, policy, social inequality.

Introduction Multiple jurisdictions are debating responses to United Nations calls for banning attempts at conversion of lesbian, gay, bisexual, transgender, queer and asexual (LGBTQA +) peoples’ identities to fit religious norms. This paper aimed to examine Australian LGBTQA + youths’ experiences and outcomes of religious conversion practices attempting to change or suppress their gender or sexuality. It explored how attending conversion practices related to demographic characteristics and outcomes. Methods A 2019 online health and social well-being survey promoted via diverse social media questioned 6412 LGBTQA + Australians aged 14–21 years on their experiences of sexuality or gender change or suppression practices. Descriptive and inferential analyses were performed to understand relationships between exposure to conversion practices and demographic, socio-behavioural, and health and well-being measures. Results Whilst most participants had never attended counselling, group work, programs or interventions aimed at changing their sexuality or gender identity, 4% had attended such conversion practices. Analyses showed associations between engaging with conversion practices and (1) specific demographics (being cisgender male, multi-gender-attracted, unemployed, affiliated to a religion at the personal or household level); (2) social experiences (increased exposure to social rejection, negative remarks and harassment); (3) socio-behavioural outcomes (decreased education, sport and housing opportunities) and (4) negative health and mental health outcomes (including increased suicidality and self-harm). Conclusions The paper showed that conversion practices are correlated with poor well-being outcomes, providing arguments for expanding inclusive health and mental health services allowing for affirming religious and non-religious identities for LGBTQA + youth. Policy Implications The paper provides evidence supporting bans on conversion practices.

Young people's sexual health is a major concern worldwide and in Australia. The sexual behaviour of young people has changed over the past 50 years -with a trend towards first sex at an earlier age, 1 and high rates of unprotected sexual intercourse among young women and men. 2 While an AIDS/HIV epidemic seems to have been prevented successfully in Australia, infection rates for sexually transmissible infections, such as chlamydia, have recently increased significantly among young people in Australia. 3 At the same time, sources of information about sexuality and sexual behaviour are increasingly readily available to young people, yet these are extremely varied in their reliability.In this context, school-based sexuality education is increasingly important in assisting young people to find reliable information, supporting their decision-making, reducing risky sexual behaviour and consequently preventing the increase in sexual infections. 2,[4][5][6][7][8][9][10] In fact, young Australians themselves nominate school programs as one of the sources they use most for information on sexual health. 11 While there has been some criticism that topics such as loving relationships and homosexuality are not routinely covered, 12 school education remains of primary importance in preparing young people for healthy and enjoyable sex lives.Hence, we need to ask the question whether teachers are adequately trained to deliver effective sexual health education and to influence young people's sexual behaviour. Pre-service teacher training is clearly one important component of effective sexuality education in schools and is an opportunity to build a sound foundation for this work. It can help to reduce common barriers and challenges in the implementation of sexuality education at school level and improve teaching quality simply by making teachers feel more confident. 13,14 Yet, very little is currently known about the pre-or in-service training delivered by universities and colleges to prospective teachers of sexuality education. Studies in this area are either out-dated or do not exist. [15][16][17] To better understand the current situation of sexuality education at school and the barriers for implementing effective programs, more research on educators and their experiences within the context of professional development is needed. Thus, we reviewed the broader curriculum and policy content for sex education in Australian tertiary teaching institutions, as well as the availability and content of preservice teacher training.* First, the review included desk research of internet resources identifying sexuality, health and physical education content listed by teacher registration institutions as well as universities and colleges. Second, 15-min phone interviews were conducted with key contacts at each participating teaching institution (mostly course coordinators or lecturers specialising in health education) to validate the inclusion and content of sexuality education topics, whether these were compulsory and how many hours were all...

Introduction High rates of illicit drug use have been reported among gay and bisexual young men, however limited research has examined patterns of drug use among the broader population of lesbian, pansexual, trans and gender diverse, asexual and queer (LGBTQA) young people. We examined factors associated with illicit drug use in the past 6 months and lifetime experiences of self‐reported concern with drug use among LGBTQA youth in Australia. Methods A cross‐sectional survey was conducted involving 6418 LGBTQA participants aged 14–21 years, 5914 of whom provided information relating to their use of illicit drugs. Multivariable logistic regressions examined demographic factors and life experiences associated with drug use in the past 6 months and lifetime experiences of self‐reported concern with drug use. Results Overall, 26.4% of participants aged 14–17 and 41.9% aged 18–21 reported any drug use in the past 6 months, of whom 23.5% had ever been concerned about their drug use. Cannabis use was most commonly reported (28.3%), followed by ecstasy/MDMA (7.1%), antidepressants (5.6%) and LSD (3.5%). Higher odds of drug use were reported among cisgender men and those who had experienced homelessness or sexual harassment in the past 12 months. Higher odds of self‐identified concern about drug use were observed among participants reporting challenging life experiences. Discussion and Conclusions Rates of illicit drug use among LGBTQA young people in this study were considerably higher than those observed in general population youth studies in Australia and were further elevated among those who had experienced LGBTQA‐related prejudice or harassment, or homelessness.