Improving Gender and Sexuality Inclusivity of a Long-Running HIV Behavioural Surveillance Survey to Identify New Sexual Practices, HIV Risks, and Maintain Community Support: A Mixed Methods Study

Inclusive language in data collection is essential for effective and sustained engagement with marginalised populations. The historic use of imprecise conceptualisations of gender and sexuality in the field of HIV and sexual health research has been challenged in the last decade, particularly cisnormative and monosexist assumptions about identity and practice. This study reports on the process of redesigning a repeated cross-sectional survey questionnaire in Australia to improve gender and sexuality inclusivity. The Gay Community Periodic Surveys (GCPS), repeated since 1996, was redesigned in 2023 to be more inclusive of transgender men, non-binary people, and bi + participants. Changes included a title change (GBQ + Community Periodic Surveys), adoption of gender-neutral language, a shift from an exclusive focus on anal sex, enhanced questions about sex with female partners, new questions about non-binary partners, and better recognition of non-monogamous relationships. Mixed methods were employed to inform and evaluate these changes, including cognitive interviews (n = 30) with a diverse range of gay, bi+, and queer men (cis and trans) and non-binary people, and rapid field interviews (n = 39) with participants who had completed the new questionnaire. Thematic analysis showed that the changes were acceptable, but the maintenance of some cisnormative assumptions about bodies and practices were also observed. The questionnaire will continue to be adapted to recognise a broader range of practices and risks within new subgroups of gay, bi, and queer men and non-binary people, with sensitivity to community expectations about survey length and comprehensibility of terms.