Syphilis incidence has been steadily increasing among
HIV-infected men in the United States, representing an important public health
challenge to HIV prevention. Clinic-based HIV prevention interventions are
available but may need to be revisited in response to syphilis epidemic. We
wanted to better understand the current epidemiology of syphilis in rural
HIV-infected men who routinely received HIV risk-reduction counseling in order
to plan more effective HIV prevention strategies in clinical care.
We conducted a retrospective cohort study to examine factors
associated with syphilis infections in rural HIV-infected men who received
sexually transmitted disease screening and HIV risk-reduction counseling during
HIV primary care from January 2008 to June 2013. We assessed patients’
demographic, clinical, behavioral and psychosocial characteristics and
performed a multivariable exact logistic regression to identify factors related
to syphilis.
Despite routine risk screening and HIV risk-reduction
counseling, a total of 51 syphilis infections were diagnosed among 702
HIV-infected men (5 patients were diagnosed ≥ 2 episodes). The majority of the
study participants was sexually active and reported at least one unsafe sexual
behavior, mainly inconsistent condom use. Younger age (<35 years, adjusted
odds ratio, higher educational attainment (some college or above), and perception that the partner may have sex with other people were significantly associated with syphilis infection. Non-injection
drug use was related to syphilis in HIV-infected men who have sex with men.
Some HIV-infected men, especially young, educated men, or
those who perceived that their partners may have sex with other people, continue
to have high-risk behaviors that increase their own risks of acquiring syphilis
and may also facilitate HIV transmission. New strategies need to be developed
for HIV primary care providers to help HIV-infected patients maintain safer sex
practices.
Table 2b
Sexual practices among 505 sexually active HIV-infected men in Pennsylvania, 2008-2013.
| Sexual practices in the past 12 months* | Total N(%) | Syphilis N (%) | Non-syphilis N (%) |
|---|---|---|---|
| Have had new partner(s) ** | 241 (47.7%) | 28 (70.0%) | 213 (45.8%) |
| Oral sex history | 355 (70.3%) | 31 (77.5%) | 324 (69.7%) |
| Anal sex history ** | 245 (48.5%) | 27 (67.5%) | 218 (46.9%) |
| Have had any unsafe sexual behaviors ** | 339 (67.1%) | 33 (82.5%) | 306 (65.8%) |
| Inconsistent condom use * | 300 (59.4%) | 29 (72.5%) | 271 (58.3%) |
| Sex under the influence of alcohol or drugs | 119 (23.6%) | 14 (35.0%) | 105 (22.6%) |
| Exchange of sex for money | 13 (2.6%) | 0 (0%) | 13 (2.8%) |
| HIV disclosure: “Partner(s) know you have HIV”** | 452 (89.5%) | 32 (80.0%) | 420 (90.3%) |
| Partner(s) have HIV | 185 (36.6%) | 17 (42.5%) | 168 (36.1%) |
| Perceived partner’s behavior: “Partner(s) have sex with other people (Yes or uncertain)” ** | 234 (46.3%) | 30 (75.0%) | 204 (43.9%) |
*Missing values to some questions were excluded from the analysis.
**The distributions were statistically different (P<0.05) between syphilis and non-syphilis HIV-infected men.
2Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA, 17033, USA
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